PATTERN OF CHEST INJURIES IN FATAL ROAD TRAFFIC ACCIDENTS- AN AUTOPSY STUDY

BACKGROUND India is a signatory to the Brasilia declaration and is committed to reduce the number of road accidents and fatalities by 50% by 2020. However, with one of the highest motorisation growths in the world accompanied by rapid expansion in road networks and urbanisation over the years, our country is faced with serious impacts on road safety levels. Trauma to the chest is the second most common injury found in road traffic accidents. Chest injuries accounts for 25% of deaths in trauma victims. It is second only to traumatic brain injury in mortality. The aim of this study is to analyse the pattern of chest injuries in fatal road traffic accidents. MATERIALS AND METHODS An autopsy-based descriptive analysis was conducted. Sample Size-A total of 161 cases of fatal road traffic accidents with chest injuries was studied during the period of 12 months from 04.02.2016 to 03.02.2017. Source Population-All cases of fatal road traffic accidents with chest injuries brought for post mortem examination to the Department of Forensic Medicine, Govt. Medical College, Kottayam during the study period was included in the study. Inclusion Criteria-All autopsies in which death was due to chest injuries in road traffic accidents were included in the study. Exclusion Criteria-All unidentified bodies and cases in which proper history was not available. Data Collection-Baseline data like age, sex, height, weight and a brief history of the case were collected from the relatives and investigating officers. A detailed information regarding the nature, time of accident, type of vehicle involved, and category of victim were recorded from the investigating officer and hospital records in case of treated cases. Details of external injuries and chest injuries are recorded in the proforma. Analysis-Data collected was entered in MS-Excel and analysed using IBM SPSS Version 16. RESULTS Among the 161 cases of fatal road traffic accident victims with chest injuries, 136 (84.5%) were males and 25 (15.5%) were females. Maximum number of victims, 57 (35.4%) were in the age group of 45 - 60 years. Maximum number of accidents, 34 (21.1%) occurred in the month of August and least occurred in the month of October (3.1%). Maximum number of accidents (41.6%) occurred during the time 12 PM to 6 PM and least occurrence (4.3%) was between 12 AM to 6 AM. Two wheelers were the commonest vehicles involved (53.4%) followed by car (31.7%). In case of collisions, cars colliding with two wheelers was the commonest (14.3%) followed by two wheelers colliding with heavy vehicles (13%). Majority of victims involved were pedestrians (38.5%) followed by motor cyclists (35.4%). Among the motor cyclists, those wearing helmets were 17 (10.6%) and those occupants with seat belts were only 2 (1.2%). Among the driver, 22 (13.7%) were under the influence of alcohol and among the other victims 29.2% have consumed alcohol. Among the fatal cases 10.6% died on the spot, 38.5% died within 6 hours and 41.6% died within 24 hours. Sternum was fractured in 34.2%, bilateral rib fractures seen in 54.6% and unilateral fracture in 45.4%. Regarding fracture of thoracic vertebrae, the 4th thoracic vertebra was fractured in 11 (6.8%) followed by fracture of 1st and 12th thoracic vertebrae in 4 (2.5%) cases each. Both clavicles were fractured in 6 (3.7%). Right lung showed contusion in 58.4%, while left lung was involved in 65.9%. Laceration of right lung was seen in 40.4%, while left lung was involved in 37.9%. Laceration of aorta was seen in 26 (16.1%) cases. Contusion of heart was seen in 34 (21.1%) cases. Laceration of heart was seen in 6 (3.7%) cases. Associated injury to head was seen in 121 (75.2%) cases. Of which 25.5% had intracranial haemorrhages and 49.7% had fracture of skull. Fracture of cervical spine was seen in 19 (11.8%) cases, while 44.7% showed fracture of any of the limbs. Laceration of liver was seen in 54 (33.5%) and spleen was lacerated in 11 (6.8%) of cases. CONCLUSION The mechanism and circumstances of blunt chest injury due to road traffic accidents can be assessed in relation to the number and localisation of rib fractures as well as the presence of injuries to lung, heart and major blood vessels. The most common cause of death 82 (50.9%) was combined injuries to head and chest followed by injuries to head, chest and abdomen 38 (23.6%) and only 6.8% of cases died due to chest injuries alone.