Background- Accidents
occur not only due to ignorance but also due to carelessness, thoughtlessness
and over confidence. Human, vehicularand environmental factors play role
before, during and after a RTA. Evidence from studies show that like all other
injuries road traffic injuries are partially predictable and hence preventable.
Objectives- To
study the pattern of road traffic accidents, socio demographic profile of road
traffic injury victims seeking care at Maharishi Markandeshwar Institute of
Medical Sciences And Research, Mullana and to
study the antecedent factors influencing the road traffic accidents.
Material And
Methods-The present cross sectional study
was carried out at Maharishi Markandeshwar Institute Of Medical Sciences And Research (MMIMSR),
Mullana (Ambala). All the victims who reported MMIMSR emergency and various OPD
clinics of the institute between September 2009 to February 2011 were included
in the study. Various parameters like age and sex distribution, time of
occurrence, protective gears worn, injuries sustained, receipt of First -Aid,
alcohol consumption, category of road user, vehicles involved in RTA, types of
Road Traffic Injuries(RTI), road conditions, environmental conditions etc were
studied and valid conclusions were drawn.
Results- There was a
marked male preponderance (88.77 %) with maximum involvement of younger age
groups. Most of the accidents had taken place in
the evening hours (6.1pm - 12.00 midnight). The vulnerable road users
like motorized two wheeler, LMV and pedestrians constituted 41.52%, 19.39% and
13.41% respectively. Only 158 of 545 two-wheeler users wore a helmet at the
time of injury. 16.24% of drivers did not had valid driving license. Not using
indicator lights and not following speed limits were two most common factors
responsible for these RTA.
Keywords: Road Traffic Injuries,
Accidents, Factors, Epidemiological study.
INTRODUCTION
Road Traffic injuries have
emerged as a major global public health problem of this century and are now
recognised as “veritable neglected pandemic”. The problem is so severe that, by
2020, it is projected that road traffic disability-adjusted life years(DALYs) lost will move from being the
9th leading cause of disability-adjusted life years lost to the 3rd
leading cause in the world and will be 2nd leading cause developing
countries.1,2
The
magnitude ofRoad traffic accidents(RTAs)and fatalities in India is alarming. In
2009, 4.22 lakh road traffic accidents and 1.27 lakh road traffic fatalities
were reported. These numbers translate into one road accident every minute and
one road accident death every four minutes. However, this is an underestimate,
as not all injuries are reported to the police.3
Human, vehicular and
environmental factors play roles before, during and after a trauma
eventtherefore accidents have to be studied in terms of an epidemiological
model (agent, host and environmental factors) and analyzed in relation to time,
place and person distribution. The objective of this study is to find
out the pattern of road traffic
accidents, socio demographic profile of road traffic injury victims and
antecedent factors influencing these RTAsreported to the hospital.
MATERIALS AND METHODS
The present cross sectional study
was carriedout at Maharishi Markandeshwar Institute Of Medical Sciences And Research (MMIMSR),
Mullana (Ambala). All the victims who reported MMIMSR emergency and various OPD
clinics of the institute between September
2009 to February 2011 were included in the study.
For the
purpose of study, a road traffic accident was defined as any vehicle accident
occurring on a public road or highway and includes vehicle accidents where the
place of occurrence is unspecified.Information was collected by interviewing victim or
his/her attendant using a structured interview schedule.
A detailed proforma
for the purpose of recording socio-demographic profile of victims,
epidemiological data, details of circumstances leading to accidents and other
relevant data etc was prepared for the purpose of filling observations of the
present study. The collected data wasentered in Microsoft Excel. Coding of the
variables was done. SPSS version 11.5 was used for analysis.Interpretation of
the collected data was done by using appropriate statistical methods like
percentage and proportions.
RESULTS
(A) Socio-demographic profile of the victims
Total 1238 accident
cases were included in the study. Majority of the victims (984 cases) were in
the younger age group of 15-50 years (79.47%).433 cases(34.97%) were recorded
in the age group of 25-39 years. Children less than 14 yrs and elderly
(>60yrs of age) made up a little 176 cases (14.21%).1099 (88.77%) of the
victims were males with 139 (11.23%) of them being females.
Majority of the
victims were Hindus998 (80.62%) with Muslims and Christians forming 18.98% and
0.40% respectively. Of the 1238 victims interviewed 925 (74.72%) were married
accounting for 74.72% of the victims, while 313 (25.28%) were not married (for
analysis purpose even victims less than marriageable age were included in the
not married group).
Majority of the
victims had had a primary level of education 31.02%, while 20.27% of the
victims were illiterates. 14.46% of the victims had a degree only one victim
had a professional degree. 27.95% of the victims had a secondary education. 22.62%
of the victims were unskilled labourers like manual labourers and farmers etc. 25.53%
of the victims were semi skilled, which included drivers (taxi, auto, maxi cab
etc) all the female victims were housewives accounting for 6.70% of the
injuries.
(B) Pattern of injuries
Out of the total
1238 (100%) RTA cases, 118(9.53%) had injuries of upper limb, 297 (23.99%) had
injury of lower limb, 495 (39.98%) had injury on the abdomen and 328 (26.49%)
had multiple injuries at more than one site. (Table-1)
Table -1:Pattern of
injuries
|
Part
involved in RTI
|
Number of
victims(%)
|
|
Upper limb
|
118 (9.53)
|
|
Lower limb
|
297 (23.99)
|
|
Abdominal
|
495 (39.98)
|
|
Multiple
|
328 (26.49)
|
|
Total(%)
|
1238 (100)
|
|
|
|
|
Severity of
RTI/TIS
|
|
|
Mild
|
688 (55.58)
|
|
Moderate
|
389 (31.42)
|
|
Severe
|
161 (13)
|
|
Total (%)
|
1238 (100)
|
|
|
|
|
VULNERABLE ROAD USERS
|
|
|
Pedestrian
|
166
(13.41)
|
|
Cyclist
|
112
(9.05)
|
|
Motorized
two-wheeler
|
514
(41.51)
|
|
3
wheeler
|
112
(9.05)
|
|
LMV
|
240
(19.39)
|
|
HMV
|
68
(5.49)
|
|
Tractor
|
13
(1.05)
|
|
Others
|
13
(1.05)
|
|
Total
|
1238
(100)
|
Severity of injuries
The severity of
injuries suffered by the victims was graded according to the “Trauma Index”4.
According to this index injuries are classified as mild injuries (0-7),
moderate (8-18) and severe injuries (more than 18). So in this study it was
observed that 688
(55.58%) had a score of 0-7
and categorized under minor injuries, 389 (31.42%) had a score of 8-18 and categorized under moderate injuries and
161 (13%) had > 18 injuries and put under the category of severe
injuries. (Table-1)
Ailment at the time of injury
Among the victims
223 (18.01%) of them gave a history of having consumed alcohol within 6 hours before
the RTI, whereas 1015 (81.99%) of them had not consumed. children were grouped
under ‘NO’ for simplification, however, no information was collected as to the
type or quantity of alcohol consumed.
Type
of vehicle involved Majority
of the victims were two wheeler occupants (riders or pillions) and occupants of
Light Motor vehicles 41.51% and 19.39% respectively. Pedestrians became victims
in 13.41% of cases. Cyclists and occupants of 3 wheelers made up 9.05% each.
(Table-1)
(C) Antecedent Factors
Days of occurrence of
injury:In the present study, 670 (54.12%)
accident cases were reported on week days i.e. Monday-Fridays and remaining 568
(45.88%) on weekends i.e. Saturdays and Sundays.
Time of occurrence of injury:497
(40.15%) of the RTIs took place between 6.1pm-12midnight, followed by 357 (28.84%)
between 6am-12 noon. 114 caseswith least
RTIs occurred between12.1am -6 am (9.21%).
(Table-2)
Table -2:Antecedent
Factors
|
Time of Injury
|
Percentage
|
|
Morning(6am-12
noon)
|
357 (28.84)
|
|
Afternoon(12.1pm
-6pm)
|
270 (21.80)
|
|
Evening(6.1pm-12midnight)
|
497 (40.15)
|
|
Night(12.1am
-6 am)
|
114 (9.21)
|
|
Total
|
1238 (100)
|
|
|
|
|
What hit you?
|
|
|
Unknown
|
32 (2.58)
|
|
Cycle
|
20 (1.62)
|
|
Motorized
two-wheeler
|
260 (21.0)
|
|
Three
wheeler
|
130 (10.50)
|
|
LMV ( car,
jeep, van)
|
322 (26.01)
|
|
HMV(bus/truck)
|
160 (12.92)
|
|
Tractor
|
44 (3.55)
|
|
Other
vehicle
|
25 (2.02)
|
|
Self fall
|
89 (7.19)
|
|
Animal
|
36 (2.91)
|
|
Trees
|
111 (8.97)
|
|
Electric
pole
|
09 (0.73)
|
|
Total
|
1238 (100)
|
|
|
|
|
Type of collision
|
|
|
Head on
|
204 (16.48)
|
|
Sideways
|
650 (52.50)
|
|
From
behind
|
173 (13.98)
|
|
NA
|
211 (17.04)
|
|
Total
|
100
|
Place of injury
48% of the RTIs
occurred outside the city, whereas 32% of the injuries occurred inside the
city. 20% of the RTIs took place on the outskirts of Ambala.
Where injury occurred?
Majority of the
RTIs took place on main roads 73.8%, followed by near junctions, 14.2% and
cross roads 12.0%.
What hit you?
The vehicles
involved in injuring the victims were LMVs most of the times 322
(26.01%) followed
by motorized two wheelers 21.0% of the times. HMV hit the victims in 12.92% of
the cases. 18 (7.19%) victims said that they sustained injury by self-fall,
followed by tractor hitting the victim in 3.55% of the time.
Type of collision Majority of the times it was a sideways collision 52.50% of the
times, followed by head on collision 16.48% of the times. 13.98% of the times
the victims were hit from behind. (Table-5)
Local environmental condition of the place of injury: Majority of the victims 1045 (84.41%) responded that the road
on which the RTI took place was tarred. 149 (12.04%) of the victims responded
that the road was rough and 48 (3.88%)
of them responded that the road was wet at the time of injury. 822 (66.2%) of
the victims said that the lighting was adequate at the time of occurrence RTI
(Injuries that took place during day time were included under ‘adequate’
lighting for analysis). 340 (27.46%) of the victims said that there was no
lighting at the site of injury occurrence and 77 (6.22%) of them said that the
lighting was inadequate.
Medical aid at the site of injury
Only 4.12% of the
victims mentioned that there was medical aid available at the site of injury
(within 500 meters from the site of injury).
How injury occurred?
Majority of the
victims were injured while there crossing a road 875 (70.68%), 231 (18.66%) of
them were injured while they were walking or riding by the side of the road
(foot path). 131(10.58%) of them were injured while they were boarding or
alighting a vehicle.
Use of helmets and seat belts:
Among the 545
two-wheeler users (riders and pillion) only 158 (28.99%) of them wore a helmet
when they were injured, whereas 387 (71.01%) ofthem did not wear a helmet. 693
(55.98%) of them were other road users.
Between the 492 HMV
and LMV users only 66 (13.42%) of them used seat belt. Rest of them did not use
a seat belt.
Presence of driving licence among drivers: 201(16.24%) of drivers did not had
valid driving license.
Cause of event:
Causesresponsible for these road traffic accidents are shown
in figure-1 . Not using indicator lights, not following speed limits, no proper
road signs were most common causes responsible for road traffic accidents.
Figure-1:
Bar diagram showing causes responsible for these road traffic accidents
Post-Injury Factors
Transportation used for reaching Medical Centre
The victims were
brought to the hospital by auto 390(31.50%) of the instances, followed by
private vehicle 314 (25.36%). The police used their vehicles to bring 220
(17.77%) of the victims to the hospital. 103 (8.32%) of the victims were transported
using a taxi, whereas 61(4.93%) victims reached the hospital by bus/minibus.
Ambulances brought the victims to the hospital 150 (12.12%) of the instances.
Discussion:
The
present study revealed that majority of the RTA victims were in the age group
of 15 to 50 years (79.47%) showing maximum involvement of younger age group.
Tendency of this age group to show scarce attention to traffic rules &
regulations and use of safety devices like helmets, seatbelts, restraints etc
can be a possible explanation for the same. In a hospital based study by
Ganveer GB majority of the victims were in the age group 18-37 years.5
This shows that the people of the most active and productive age group are
involved in RTAs, which adds a serious economic loss to the community. Similar
observations were also made by Balogun JA.6
Not
surprisingly our study shows the overwhelming majority of the victims (88.77%)
were males. It is due to greater male exposure on streets. According to the
study done by Nilamber J et al in JIPMER7 study 83% (603) were males
and 123 (85.8%) were females.
Regarding
educational level of victims this study confirms the results concludedby others.8Above
observation indicates that lack of road traffic senses resulting either from
illiteracy or poor literacy may have been a significant contributory factor to
the causation of road traffic accidents.
It
was found in this study that majority of the victims 41.52 %( 514) were two
wheeler occupants. Occupants of Heavy motor vehicles accounted for 9.8% of the
victims. Cyclists accounted for 5.8% of the victims. According to the community
based study done by others.9 Majority of the victims were Two-wheeler users
46.3% (315) and pedestrians 24.9%(169), followed by cycle users (14.1%). Olukoga
A.10observed that, 61% of the victims were pedestrians. Findings
translate that the pedestrians, cyclists and two wheeler users are vulnerable
road users and need to take extra precautions when on road.
Regarding
time of occurrence of injury, findings of our studymimics
with the findings presented by a report (2009) prepared by Transport
Research Wing (TRW), Ministry of Road Transport & Highways, Government Of
India, New Delhi.3
In
the present study, the higher number of reported accident cases occurred on
week days (Monday-Fridays) 54.12%, when compared to weekends (Saturdays and
Sundays) 45.88%.Similarly others11,12also observed more accident
cases on a weekend Saturday. In another study from Delhi, the highest number of
RTAs were observed on Mondays and Wednesdays.13
It
was observed in this study that the maximum numbers of injuries were seen in
the abdomen and the least in the upper limb. This is in contrast to the study
by Biswas G 14who cited that the maximum (56.4%) injuries were found
on head and neck, followed by thorax (54.5%) and abdomen (44.5%). External
injuries were found more than 905% cases. Other studies15,16also
showed a high incidence of head injuries in their series on RTAs. These studies
contradict the observations on this aspect of the study.
It
was seen that not following speed limits and not using indicator lights were
two main causes in more than half of the total RTIs.
Since one accident had one or many predisposing factors so these factors are
more than the actual cases. Clarke DD17 found high speed vehicle
predisposing factor in 65% of accidents.
Conclusion
Present study showed that RTAs
were more common in the younger age groups.Good numbers of drivers were found
without valid driving license.The study highlights the need of compulsory
implementation of helmet wearing for motorcyclist and necessitates the needfor
taking urgent steps for establishing ambulance services and provision of pre-hospitalcare
& trauma services. Strict legislation should be adopted in dealingwith
rash, negligent driving and driving under theinfluence of alcohol.
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