Abstract
With the advancement in the automotive industry throughout the world, presently road traffic injuries have become one of the relevant factors to cause considerable losses to individuals, their families and to nations as a whole in many aspects. A retrospective observational study was conducted at Raiganj Govt. Medical College & Hospital, a tertiary care center of Uttar Dinajpur, a peripheral district of West Bengal, between January 2022 and December 2023, to analyze the injury pattern in a total of 288 autopsy cases with a history of road traffic accident (RTA), and to draw public attention and awareness to encounter it.
The study shows that deaths are more in the age group of 21–30 years (19.44%), Males (73.61%) are more affected than females (26.39%), and two-wheeler riders are the most frequent victims (38.89%). Coexistence of multiple blunt injuries, that is, abrasion, bruise or contusion, laceration, along with fracture of bones commonly noted during the postmortem examination of RTA victims (64.93%). Head injury is the main or associated factor of causing death in 82.64% cases.
Introduction
An accident is an event that occurs suddenly, unexpectedly, and inadvertently under unforeseen circumstances. 1 An accident that takes place on the road involving a vehicle is termed a road traffic accident (RTA). 2 RTAs have emerged as a major public health concern of this century throughout the world and are now recognized as a “veritable neglected pandemic.” 3 Eventually, every year, the incidence of RTA suppresses the data of the previous year. Our own country, India, is also not an exception in this case.
The pattern of injuries resulting from RTA depends on several factors. Key contributing factors include human error, driver fatigue, inadequate traffic awareness, mechanical failures, excessive speed and overtaking, violations of traffic regulations, substandard road conditions, traffic congestion, road encroachment, and driving under the influence of alcohol. 4 Victims in RTAs sustain a variety of injuries, external as well as internal. Early detection of the injuries and prompt treatment are necessary to save the lives of many of these victims. A careful and detailed study of injuries helps in the reconstruction of RTAs, especially in hit and run cases, which in turn help the investigating agencies to identify & prosecute the offenders who are responsible for the accident. In addition, the study of injuries associated with fatal outcomes helps in the implementation of measures to prevent fatalities due to RTAs. 5
The present study was therefore conducted to ascertain the incidence of fatal RTAs that occurred in Uttar Dinajpur, a peripheral district of North Bengal, and patterns & distributions of injuries with emphasis on demographic profile from autopsy cases done at the mortuary of Raiganj Govt. Medical College &Hospital, which can be used for the strategical development to prevent fatality due to RTA, and to educate public about road safety.
Materials and Methods
After getting the ethical clearance, a retrospective study was conducted on the dead bodies that died due to RTA and were sent for postmortem examination in the mortuary of Raiganj Govt. Medical College & Hospital, a tertiary care center of Uttar Dinajpur, a peripheral district of North Bengal, from January 2022 to December 2023. Detailed information was based on inquest reports, medical records, and evaluation of postmortem reports. Age, sex, nature of collision, survival period, internal & external injuries, distribution of head injuries, and cause of death were the primary points to analyze & prepare a data sheet. After that, an interpretation of the collected data was done by using appropriate statistical methods.
Results
During the study period, a total of 288 medicolegal autopsies were conducted in connection with RTA. Males outnumbered the females in the total number of deaths due to RTA, 212 (73.61%) male cases compared to 76 (26.39%) female cases (Table 1).
Frequency Distribution of the Study Population in Different Sex.
The age group of 21–30 years was commonly affected (19.44%), followed by 31–40 years (17.36%). The deceased aged more than 70 years were the least (3.47%). The youngest victim was a 3-year-old male child, and the oldest was a 93-year-old female (Table 2).
Frequency Distribution of Study Population According to Different Age Groups.
In the present study, two-wheeler riders were the most frequent victims (38.89%), followed by pedestrians (26.39%), four-wheeler riders (21.53%) and three-wheeler riders (11.46%) (Table 3).
Frequency Distribution of Study Population According to Type of Road Users.
Following the accidents, most of the victims (66.67%) declared as “brought dead” at hospital followed by 22.22% of total victims died within 12 hours of accident, 5.55% died within 12–24 hours, 4.17% of total victims survived for varying periods between 1 and 7 days and rest of the victims (1.39%) died after that (Table 4).
Frequency Distribution of Study Population According to Period of Survival After RTA.
Different types of blunt injuries like abrasion, bruise or contusion, laceration & fractures are noted respectively in 94.79%, 96.18%, 85.76% & 76.04% cases. Coexistence of multiple blunt injuries, that is, abrasion, bruise or contusion, laceration, along with fracture of bones commonly noted during the postmortem examination of RTA victims (64.93%), followed by coexistence of abrasion, bruise or contusion and laceration found in 13.89% victims, whereas sharp injuries are noted only in 1.04% cases (Table 5).
Frequency Distribution of Study Population According to Type of Injuries.
Isolated head injury was found to be the leading cause of death in our study (34.72%). Upper or lower limb injuries were found as an associated factor along with head injury to be the cause of death in 17.36% of total cases, whereas isolated abdominal or pelvic injuries were found to be the cause of death in 6.25% cases (Table 6).
Frequency Distribution of Study Population According to Cause of Death.
Out of the total 288 medicolegal autopsies, head injury was the main or associated factor of the cause of death in 238 cases. Among these, coexistence of scalp injury & skull bone fracture along with EDH or SDH or SAH was noted in 55.46% cases, followed by coexistence of scalp injury & EDH or SDH or SAH noted in 26.89% cases. Whereas only scalp injury was noted in 6.72% cases (Table 7).
Frequency Distribution According to Nature of Head Injury.
Discussion
In the present study, males outnumbered females in the total number of deaths due to RTA, like many other studies.6, 7 This male predominance is expected because of the socio-economic culture of our country, where most of the outside work is usually done by males, and they tend to violate the traffic rules & regulations, driving under the influence of alcohol, and aggressiveness compared to females.
The most vulnerable age group commonly affected, according to the present study, was 21–30 years, followed by 31–40 years (19.44% & 17.36%, respectively), and the least affected age group was above 70 years (3.47%). The young age group has a tendency to show less attention to traffic rules & regulations, along with non-use of safety devices like helmets, seatbelts, etc. This is a possible explanation for the same. Similar kinds of results have also been found in other studies from different parts of India.8–10
Regarding the victims’ status, the present study showed that the primary target of fatal RTAs was two-wheeler riders (38.89%), followed by pedestrians (26.39%). This is similar to a study done by Manoranjan B, Somashekhar SP, et al. in Karnataka, India. 11 A modern-day common trend of rash and negligent driving of over-designed motor vehicles by the young generation without wearing helmets might be the main reason behind this type of tragedy.
In the present study, most of the victims died “on the spot” or before being brought to any trauma or medical care center (66.67%), followed by 22.22% of total cases that died within 12 hours of hospitalization. These findings also correspond with other studies.12, 13
Coexistence of different types of blunt injuries, that is, abrasion, bruise or contusion, laceration & fractures are found in most of the victims (64.93%). Those injuries are produced by forcible impact with hard, blunt objects, which are very common in RTA cases. On the contrary, sharp penetrating injuries are seen only in three cases (1.04%), which may be produced by different projecting objects, either from vehicles or from the surroundings.
Solely head injury was found to be the most common cause of death in our study (34.72%), followed by the coexistence of head along with upper or lower limb injuries (17.36%). Head injury associated with other regional injuries proved to be fatal in 238 cases (82.64%). Among the total 238 head injury cases, fracture of the skull was noted in 150 cases (63.02%), and intracranial hemorrhages were found in 222 cases (93.28%). Head injury is also noted as a major cause of death in other studies done by Salgado (69.6%) & Biswas G (47.3%).14, 15 In maximum cases head becomes the affected part either due to primary or secondary impact in RTA.
Conclusion
RTA, being a grave concern in public health, is associated with a considerable number of deaths in our country. Contributory factors, from reckless driving to poor road conditions, are already under scrutiny of the appropriate authorities. However, the distribution of primary impact injury and other associated injuries found during this study indicates a huge number of cases contributed by the victims themselves. Most of the cases occurred on the National Highway and near some specific areas, with a lack of vigilance and social awareness.
Appropriate measures need to be taken to reduce the number of accidents, like: frequent check posts, proper signage, construction of overbridges near high-speed zones, etc. Awareness as well as prevention are the keys to reducing RTA-related deaths.
One well-equipped trauma care center with neuro-surgical facilities needs to be established locally to give proper treatment of head injuries due to RTA, as it is found to be the most common cause of death in our study, so that precious lives can be saved within the crucial first few hours after the accidents.
Footnotes
Acknowledgement
No other person has made substantial contributions to this manuscript.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical Approval and Informed Consent
Taken from the Institutional Ethical Committee of Raiganj Government Medical College. The study was conducted over the dead bodies brought for medicolegal postmortem examination & identity of the individual was not revealed. So informed consent from the next of kin was not required.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
