Amrita Journal of Medicine

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 16  |  Issue : 1  |  Page : 9--12

Clinical profile of road traffic accident victims


Amrutha Valsalan1, TP Sreekrishnan2, B Sabarish2, BS Dhanasekaran2, KP Gireeshkumar2,  
1 EMT, Division of Transport Medicine, Department of Emergency Medicine, AIMS, Kochi, Kerala, India
2 Department of Emergency Medicine, AIMS, Kochi, Kerala, India

Correspondence Address:
Dr. T P Sreekrishnan
Department of Emergency Medicine, AIMS, Kochi, Kerala
India

Abstract

Background: India is a country with very high mortality rates due to road traffic accidents (RTAs). Two-wheelers are the most common vehicle involved in the RTAs. This study aimed to describe the overall characteristics of RTAs. Objective: The objective was to study the clinical profile of trauma patients presenting to the emergency department of a tertiary care center. Methodology: A total of 200 patients were enrolled in the study. A preorganized datasheet was prepared for each patient attending the Emergency Department of Amrita Institute of Medical Sciences. It contains data about sociodemographics, trauma data, clinical evaluation result, as well as treatment strategies. Results: Most (31%) of the patients were aged between 20 and 30 years. The mean age of the patients was 35.8 years. There were 156 males (78%) and 44 females (22%). More than half of the patients were from urban areas. Most patients (82%) were injured by two-wheelers. Sixteen patients did not wear helmet, in which eight patients (50%) had a head injury. Conclusion: Trauma is a major health problem, especially in the young population in our country. Two-wheelers are the most common vehicle involved in the RTAs. Trauma is the leading cause of morbidity and mortality among all age groups, and injuries from RTA is the most common cause of disability in the developing world.



How to cite this article:
Valsalan A, Sreekrishnan T P, Sabarish B, Dhanasekaran B S, Gireeshkumar K P. Clinical profile of road traffic accident victims.Amrita J Med 2020;16:9-12


How to cite this URL:
Valsalan A, Sreekrishnan T P, Sabarish B, Dhanasekaran B S, Gireeshkumar K P. Clinical profile of road traffic accident victims. Amrita J Med [serial online] 2020 [cited 2020 Sep 18 ];16:9-12
Available from: http://www.ajmonline.org.in/text.asp?2020/16/1/9/289137


Full Text



 Introduction



Road traffic accidents (RTAs) are the leading cause of morbidity and mortality among all age groups.[1] Motorcycles have become an increasingly popular mode of transportation; motorcycle registration in the United States topped 8.1 million in 2007. They enjoy the freedoms that come with their chosen form of transportation, but they are also exposed to dangers. In two-thirds of motorcycle accidents involving another vehicle, the driver of the other vehicle violated the motorcycle riders right of way and caused the accidents, and it has no protective measures in the event of a crash. Female pillion riders sit sideways with both legs to the left of the vehicle because of the common mode of dress and they do not wear helmet. Helmets have repeatedly been proven to reduce the severity of the head injury in crashes. Helmet has shown a protective effect for brain injuries or skull fractures and has also been shown to reduce overall mortality. The highest combined risk of dying or being severely injured was found in males and driving at excessive speed on urban links. Driving under the effect of alcohol or drug is one of the causes of RTAs and mortality associated with it. Teens as drivers are known for rash driving impulsively and also to get away reasons. They cause accidents due to inexperience and speed. Some drivers suddenly overtake the vehicle in front, without anticipating that another speeding vehicle is coming from the opposite direction, which results in collision. It is often seen that the vehicle may suddenly take turn to either to left or to right without using indicator.

Accidents can be prevented and lives can be protected and saved after the accidents in if the injured could be transported to the trauma center or to appropriate hospitals within the golden period during which the resuscitation could salvage the patients.

 Methodology



Inclusion criteria

Patients aged 18 years or above, who had RTA.

Exclusion criteria

Patients younger than 18 years of ageBurnsElectrocutionPregnancy.

Structure and location

This is a prospective observational study done on 200 patients who had RTA and referred to Amrita Institute of Medical Sciences from November 2017 to June 2019. During the time period, a pro forma was maintained to collect the details and data regarding patients with a history of RTA. The data were collected by the emergency medical technicians.

Data collection

The clinical data were collected from a preorganized datasheet for each patient. The sociodemographic data included data regarding age, sex, marital status, occupation, residence, date and time of the occurrence of injury, type and cause of injury, time of hospital arrival, and any prehospital intervention. All of the included patients were subjected to clinical evaluation and treatment after arrival to the emergency department, as per the Advanced Trauma Life Support guidelines. The data of each patient were mentioned in the preorganized datasheet. The outcome of each patient was collected, and it was divided into the following: the patient was discharged after the treatment of trivial trauma, admitted to emergency room for observation, admitted as an inpatient for further evaluation and management or discharged later, and death. Data were collected including history and the result of clinical examination, investigation, and managements. All of them were coded, entered, and analyzed using the statistics.

Statistical analysis

The data collected were compiled using Microsoft Excel. All statistical analyses were carried out using IBM (International Business Machines Corporation) Statistical Package for Social Sciences (SPSS Version 20). Frequency and percentage were used to present categorical variable and median to present numerical variable.

 Results



This prospective descriptive study included 95 patients who had presented with RTAs in the Emergency Department of Amrita Institute of Medical Sciences and Research Center from July 2016 to June 2017. In this study, 82 patients (86%) are from urban areas and 13 patients are from rural areas. Out of 95 patients, 55 patients (57%) reached the hospital within 1 h, followed by 17 patients (17%) reaching within 5 h, eight patients (8%) reaching in 5–10 h, and other eight patients (8%) reaching in >24 h. Out of the 95 patients, 43 patients were injured within 5 km from the hospital, followed by 70 patients in >5 km, 9 patients in 25 km, 4 patients in >25 km, and 18 patients from out of Ernakulam. Fifty-one patients were injured by two-wheelers, in which 35 patients (36.8%) wore helmet and 16 patients (16.8) did not wear helmet. Majority of the patients (54, 56.8%) did not get first aid and 35 patients (36.8%) got first aid, of which 63 patients (63.3%) had minor soft-tissue injuries, 16 patients (16.8%) had major soft-tissue injuries, 17 patients (17.8%) had bony injuries, 8 patients (8.4%) had head injuries, and 1 patient (1%) had major solid organ injury. According to Glasgow Coma Scale (GCS), 88 patients (90%) showed GCS 13–15, followed by two patients (2.1%) showing 13–14, two patients (2.1%) showing 10–13 and three patients (3.1%) showing <10 [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8].{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}{Figure 6}{Figure 7}{Figure 8}

 Discussion



Trauma is a leading cause of disability and a preventable cause of death. The present study aimed to describe the pattern of different injuries in RTA patients attending the emergency department. The most common age group involved was between 20 and 30 years, followed by 31 and 40 years. According to the National Crime Records Bureau, Delhi, majority of cases were between the age group of 15 and 44 years. Similar results were found in studies conducted in Delhi by Mehta and in Nepal by Jha.[2] Unlike many chronic diseases that occur later in one's life, trauma has a disproportionate impact on young and middle-aged people. Male gender predominated in RTA patients (78%) in the present study. It was also proven by Vieira RCA, Hora EC, Oliveria DV, and Vaez AC in Sergipe.[2] It is possible to suggest that males are more liable to trauma, and hence they constitute the majority of those kind of studies.

Motorcycles are the popular mode of transportation, and motorcycle registration in the United States topped 8.1 million in 2007.[3] In this study, two-wheelers are the most common vehicle involved in the RTAs, and also most patients are injured by two-wheelers because there is no protection provided by the vehicle at the event of crash. The Incidence of Motor cycle crashes are more common in our study. Most of the victims found to sustain head injury especially because of non-adherence to wearing even helmet – 35% in our study. A similar study showed that injury preventing strategies targeting helmet usage can increase the utilization of helmet thus decreasing the incidence of head injury following motor cycle crash.[4] It has been reported that helmet reduces the probability of the occurrence of head injuries, the severity of the head injuries when they occur.[5],[6]

Most of the accidents occur in between 8 and 12 p.m; out of 200 patients, 56 patients (28%) injured at this time period in the present study. Rapid transportation to the hospital is critically important. One of the factors responsible for mortality is delay in transportation of the patient to the hospital. The golden period for survival after sustaining injury is the first 1 h. In the current study, most patients reached hospital within 20–60 min from the injury site. Fifty-five patients (57%) came within 1 h, seven patients (7.3%) came within 1–5 h, eight patients (8.4%) reached in 5–8 h, others (8%) reached in 24 h, and most of them came from another hospital for further management. Most of the patients were not subjected to prehospital intervention as they were not transported by ambulance. Moreover, 45.5% of the patients had first aid before reaching the hospital, but all first aids were received from the nearest hospital, not at the injured site. Current thinking prioritizes methods for the decrease of prehospital time by addressing only life-threatening injuries through control of bleeding, cervical spine stabilization, and similar interventions.

The majority (90%) of the patients were alert on the Alert, Verbal, Painful, Unresponsiveness scale and showed GCS 13–15: 7% of the patients showed GCS 10–13, and these patients were admitted; 3% of the patients were unresponsive and showed GCS <10, and these patients were admitted. In this study, most of the patients (48%) had mild injuries, followed by moderate injuries (40%) and severe injuries (12%).

 Conclusion



This is a retrospective observational study of 200 patients admitted to the Emergency Medicine Department of Amrita Institute of Medical Sciences, Kochi, who presented to the emergency room with RTA between July 2016 and June 2017 and satisfied the inclusion and exclusion criteria.

Out of the 200 patients, 156 (78%) patients were male and 44 (22%) patients were female. Sixty-two (31%) patients were in the age group of 20–30 years. In this study, 56 (28%) patients were injured in between 8 a.m. and 12 p.m. The current thinking prioritizes methods for the decrease of prehospital time by addressing only life-threatening injuries through control of bleeding, cervical spine stabilization, and similar interventions. A total of 164 patients (82%) were injured with two-wheelers. Based on the use of safety equipment, it was found that 130 patients (65%) did not use helmet and seat belt, so it is concluded that two-wheelers are the most common vehicle involved in the RTAs, and helmet use is very important in two-wheeler riders.

To sum up, younger age group, low educational status, and careless attitude by the pedestrians plying of slow- and fast-moving vehicles on the same road during the peak hours are the main reasons for RTAs.

Trauma is the leading cause of morbidity and mortality among all age groups, and injury from the RTA is the most common cause of disability in the developing world.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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2Jha N. Road traffic accident cases at BPKIHS, Dharan, Nepal: One year in retrospect. J Nepal Med Assoc 1997;35:241-4.
3Vieira Rde C, Hora EC, de Oliveira DV, Vaez AC. An epidemiological survey on motorcycle accident victims assisted at a reference trauma center of Sergipe. Rev Esc Enferm USP 2011;45:1359-63.
4Mock CN, Maier RV, Boyle E, Pilcher S, Rivara FP. Injury prevention strategies to promote helmet use decrease severe head injuries at a level I trauma center. J Trauma 1995;39:29-33.
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6Thomas S, Acton C, Nixon J, Battistutta D, Pitt WR, Clark R. Effectiveness of bicycle helmets in preventing head injury in children: Case-control study. BMJ 1994;308:173-6.