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Table of Content - Volume 19 Issue 2 - August 2021


 

A retrospective study of patterns, characteristics and outcome of road traffic injured patients in a tertiary care hospital

 

Chaitanya R Shetty1, Rakesh Bikkasani2*

 

1Assistant Professor, 2IIIrd Year Post Graduate, Department of Orthopaedics, Yenepoya Medical College, Mangalore, INDIA.

Email: chowdary.rakesh864@gmail.com

 

Abstract              Background: Trauma is a major public health challenge and a leading cause of deaths, morbidity and disability in india and most parts of the developing world. Motor vehicular crashes are a major cause of trauma in these countries. While developing countries are said to account for 48% of motorized vehicles, they account for 91% of fatalities due to road traffic crashes per annum. Materials and Methods: This was a retrospective hospital data-based study of outcome of RTI patients seen in a Department of Orthopaedics, Yenepoya Medical College and Mangalore from January 2020 to December 2020. A consent form was presented to all RTA victims irrespective of age, gender and severity or type of injuries attending the A and E Department of the Mayo Hospital during the study time. In the case of minors or unconscious patients, accompanying relative or caretaker were asked to consent. Total 176 road traffic accident (RTA) victims attended Accident, Emergency, Department of Orthopaedics, Yenepoya Medical College and Mangalore, study duration out of which 150 fulfilled inclusion criteria and were enrolled in the study. Results: We covered socio-demographic profiles of the RTA victims, details about the RTAs encountered by these victims, characteristics of their injuries, treatments provided and outcomes of these injuries, the effect of prehospital care on the outcomes, and environmental factors associated with RTAs. General perspective of patients regarding Road Traffic Accidents was also asked and reviewed. In the present study, High-road traffic injuries were observed in summer reason 60 (40%), winter 48 (32%) and rainy season 42 (28%). Weekends are usually the days of week when occurrence of RTA has been seen. In our study Sunday was the most common day of occurrence (21.33%) followed by Saturday (19.33%), Friday (12%), Wednesday (14%), Tuesday (13.33%) Thursday (10%), and Monday (10%). Such findings were seen in other studies also. Conclusion: Road traffic accidents constitute a major public health problem in our setting and this research has provided important information about causes of RTAs and its associated factors. Most of them are preventable and policymakers should make and enforce proper laws to ensure road safety. Helmet use must be ensured in motorcycle users to prevent head injuries and traffic rules should be strictly followed.

Key Words: Trauma, RTA, Helmet.

 

INTRODUCTION

Trauma is a major public health challenge and a leading cause of deaths, morbidity and disability in India and most parts of the developing world. Motor vehicular crashes are a major cause of trauma in these countries. While developing countries are said to account for 48% of motorized vehicles, they account for 91% of fatalities due to road traffic crashes per annum. Accidents are a major cause for killing young men aged 15-29 and the second biggest cause of disabilities and illness among adolescents.3 The United Nations (UN) General Assembly has declared the 2011-20 as the Decade for Road Safety with a goal to bring the number of global deaths and injuries from RTAs decreased to half by 2020 (Target 3.6: sustained development goals). In India, according to WHO, Road Traffic Accident is the 6thleading cause of death with a greater share of hospitalizations, deaths, disabilities and socioeconomic loses in young and middle aged population. Incidentally, India holds the dubious distinction of registering the highest number of RTAs in the world. Although it has only 1% of world’s motor vehicles, but it accounts for 6% of the total global RTA deaths. According to National Crime Bureau Survey, at least 13 people die every hour in road accidents in the country.(6) According to Experts at the National Transportation Planning and Research Centre (NTPRC) the number of RTAs in India is three times higher than that prevailing in developed countries. The numbers of accidents for 1000 vehicles are as high as 35 while the figure ranges from 4 to 10 in developed countries. Victims of Road Traffic Injuries are mostly men in the productive age group of 15-45 years and belong to the poorer section of society. During 2011, a total of 497,686 road accidents were reported by all States/Union Territories (UTs) of India. Of these, about 24.4 percent (121,618) were fatal accidents. The number of persons killed in road accidents were 142,485 i.e. an average of one fatality per 3.5 accidents. WHO, in its international conference on RTA, noted the importance of adequate data on traffic injuries. Indeed, accurate estimates of the public health burden of RTA can establish the priority of this public health problem and will provide a rational basis for policy decision. The present study is therefore an attempt to study the patterns, characteristics and outcome of road traffic injured patients in a tertiary care hospital, Mangalore.

 

MATERIALS AND METHODS

Study location: This was a retrospective hospital data-based study of outcome of RTI patients seen in a Department of Orthopaedics, Yenepoya Medical College and Mangalore.

Study period: January 2020 to December 2020.

Inclusion Criteria: RTI patients with isolated injuries were included in the study.

Exclusion Criteria: Patients who were dead on arrival at the Department of Orthopaedics, Yenepoya Medical College and Mangalore and patients with injuries in more than one anatomical region (poly-traumatized) were excluded from the study.

A consent form was presented to all RTA victims irrespective of age, gender and severity or type of injuries attending the A and E Department of the Mayo Hospital during the study time. In the case of minors or unconscious patients, accompanying relative or caretaker were asked to consent. Total 176 road traffic accident (RTA) victims attended Accident, Emergency, Department of Orthopaedics, Yenepoya Medical College and Mangalore, study duration out of which 150 fulfilled inclusion criteria and were enrolled in the study. The purpose of this research was to investigate the characteristics of injuries and the effect of pre-hospital care on their outcome in RTA victims. We modified a pre-designed questionnaire to collect data from the RTA victims. A scale of ten questions was added at the end to assess the beliefs of RTA victims about the accidents and their responsibility.

Statistical Analysis: Statistical data analysis was done using SPSS software version 23.0. Descriptive statistics were used, and data were summarized in the form of proportions and frequency tables for categorical variables. Chi-square was used to determine the effect of pre-hospital care on final outcomes. Important findings were highlighted in the form figures and charts.


 

RESULTS

We covered socio-demographic profiles of the RTA victims, details about the RTAs encountered by these victims, characteristics of their injuries, treatments provided and outcomes of these injuries, the effect of prehospital care on the outcomes, and environmental factors associated with RTAs. General perspective of patients regarding Road Traffic Accidents was also asked and reviewed.

Table 1: Age wise distribution

S.No

Age Group

Number of patients

Percentage

1

0-10 years

10

6.6%

2

11-20 years

14

9.33%

3

21-30 years

22

14.66%

4

31-40 years

42

28%

5

41-50 years

26

17.33%

6

51-60 years

17

11.33%

7

>60 years

19

12.66%

In this study, Out of 150 subjects, 123 Males and 27 females, with male to female ratio of about 8:1. Patient’s ages ranged from 5 years to 70 years. The modal age group was between 0-10 years with 10 patients, 11-20 years with 14 patients, 21-30 years with 22 patients, 31-40 years with 42 patients, 41-50 years with 26 patients, 51-60 years with 17 patients, greater than 60 years with 19 patients.

Table 2: Distribution of patients according to socioeconomic status

S.No

Socioeconomic status

Number of patients

Percentage

1

High

46

30.66%

2

Upper Middle

34

22.66%

3

Lowe middle

25

16.66%

4

Poor

23

15.33%

5

Very poor

22

14.66%

High number of RTI patients were belongs to high socioeconomic status 46 (30.66%), Upper middle 34(22.66%), Lower middle 25(16.66%), poor 23(15.33%), very poor 22 (14.66%).

 

Table 3: Distribution of patients of RTA according to the season

S.No

Season

Number of patients

Percentage

1

Rainy

42

28%

2

Winter

48

32%

3

Summer

60

40%

In the present study, High Road traffic injuries were observed in summer reason 60 (40%), winter 48 (32%) and rainy season 42 (28%).

Table 4: Distribution of patients according to day of RTA

S.No

Season

Number of patients

Percentage

1

Monday

15

10%

2

Tuesday

20

13.33%

3

Wednesday

21

14%

4

Thursday

15

10%

5

Friday

18

12%

6

Saturday

29

19.33%

7

Sunday

32

21.33%

Weekends are usually the days of week when occurrence of RTA has been seen. In our study Sunday was the most common day of occurrence (21.33%) followed by Saturday (19.33%), Friday (12%), Wednesday (14%), Tuesday (13.33%) Thursday (10%), and Monday (10%). Such findings were seen in other studies also.

 

Table 5: Characteristics of injuries and hospital stay

S.No

Characteristics

Number of participants

 

Number

of patients

Percentage

 

1

Region(s) of the body injured

150

Head

15

10%

Maxillofacial

18

12%

Abdomen

14

9.3%

Pelvis

25

16.66%

Musculoskelet al. (extremities)

43

28.66%

2

Types of fractures patient suffered from

150

Skull/maxillofacial fractures

15

10

Clavicle fractures

2

1.33

Pelvic fractures

7

4.66

Upper limb fractures

43

28.66

Lower limb fractures

35

23.33

None

20

13.33

Maxillofacial and Musculoskelet al.

10

6.66

Clavicle and lower limb

4

2.66

Upper and lower limbs

9

6

Pelvis and lower limb

5

3.33

3

Length of Hospital stay

150

Within a day

25

16.66

1-5 days

15

10

6-10 days

31

20.66

11-15 days

20

13.33

16-20 days

13

8.66

21-25 days

3

2

16-30 days

4

2.66

More than a month

7

4.66

Musculoskel et al. (extremities) was the most common region injured accounting for 55% injuries alone. 29% of patients had more than one region injured, mostly extremities and maxillofacial regions were injured together. 66 RTA victims experienced at least one open wound. 77% of RTA victims were alert at the time of admission in Yenepoya Medical College, Mangalore, 13% were responsive to verbal stimuli, and only 2% were unresponsive. Limbs were the most fractured bone region with upper limb fracture in 43 patients and lower limb in 35. Maxillofacial/skull fracture was seen in 15 patients. Multiple fractures including limb and another region e.g. maxillofacial were found in 8 RTA victims. Only 19 out of 150 RTA victims had no fracture. Out of 150 RTA victims, 25 RTA victims sustained minor injuries and were discharged within a day (after 1-2 hours) after prompt treatment/dressing of wounds. 15 patients were discharged within 1-5 days, 31 patients were discharged within 11-15 days, 13 patients were discharged within 16-20 days, 3 patients were discharged within 21-25 days, 4 patients discharged within 4 days, 7 patients were discharge after 1 month from the hospital.

 

Table 6: Final Outcome

S.No

Treatment given to the RTA victims

 

Final Outcome (N=150)

 

Discharged without

permanent disability

 

Discharged with

a permanent disability

Total

1

Yes

78

15

93

2

No

53

4

57

In our study, out of 150 RTI patients, 78 patients were discharged without permanent disability, 15 patients were discharged with a permanent disability.

 


DISCUSSION

Motorcyclists were the most injured of the road-user groups in this study. This finding is also comparable to research conducted in other countries, e.g. Tanzania. The use of motorcycles in our country has strikingly increased in the last few decades as a motorcycle is a cheaper and faster means of transportation. However, this two-wheeled vehicle is unstable, and as use of helmet is also very minimal in motorcyclists in Pakistan, as evident from the results (only 11%), it increases the risk of RTAs and puts the rider's life at risk. However, recently there has been an advancement in this regard, making helmet use compulsory for all the motorcycle driver as well as passengers in Lahore. Musculoskel et al. injuries are found prevalent in the sample population, with fractures as the most common injury encountered. Upper limbs fractures (44%) are more seen as compared to the lower limb. Other researches also show similar results in this regard, fractures, and musculoskel et al. injuries being highest in RTA victims they studied. However, a study conducted in Karachi a few years ago, showed a higher incidence of head injuries in RTA victims, contrary to the pattern observed in our research. Most of the accidents occurred as a result of a collision with another vehicle. This is also consistent with the results of research conducted in Yemen. This is due to haphazard driving seen in road users in haste to reach their destination as early as possible, neglecting many road rules. This is a preventable factor since laws can be made to control traffic and its flow, especially in developed countries. Most accidents occurred from 6 PM to 12 AM. This is in accordance with the fact that most youngsters are found on roads during this time to relax and recreate after their school or college hours. Moreover, this is closing time for almost all workplaces and people are in a hurry to reach their homes after work. Moreover, tiredness and road rage can also be a cause of Road Traffic Accidents in our population. This was also deducted by a research conducted by Sheikh in Lahore.The rescue and ambulance systems must be improved to provide more appropriate causality management at the spot and while on the way to the hospital, since time is a very crucial factor in trauma management. A study conducted in Tanzania to study RTA injuries and factors associated also emphasized on this fact. General population awareness and basic trauma management training should be ensured to prevent major human loss. This will improve first-hand management in case of an emergency or trauma, decreasing fatality and mortality in the population overall. Thus, most RTAs are preventable, and by adopting certain protective measures and by proper management of injuries sustained by victims, we can surely save many precious lives.

CONCLUSION

Road traffic accidents constitute a major public health problem in our setting and this research has provided important information about causes of RTAs and its associated factors. Most of them are preventable and policymakers should make and enforce proper laws to ensure road safety. Helmet use must be ensured in motorcycle users to prevent head injuries and traffic rules should be strictly followed. Pre-hospital care has proved to be an important factor in preventing fatalities. As a result, steps should be taken to provide this facility in every setting. Proper arrangements for providing pre-hospital care to the victims should be made through improved ambulance network and trained rescue workers. First aid education should be given in every institute. This will help in improving the quality of life in casualty victims. Minor injuries are being brought in tertiary care hospital. This should be organized by implication of proper triage system, so that severely injured patients can be better treated and taken care. In this respect, Specialized Trauma centers should be established in hospitals and separately in different areas. Doctors and paramedics should be trained there to manage and treat trauma patients e.g. RTA patients. This will take healthcare delivery to a much higher level. In order to prevent citizens from such casualties, disabilities and fatalities, awareness and education regarding traffic rules and preventive measures should be given to the general population.

 

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