RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address DR. SHODHAN RAO PEJAVAR (in block letters) POST GRADUATE, DEPARTMENT OF FORENSIC MEDICINE AND TOXICOLOGY, M.R. MEDICAL COLLEGE, GULBARGA.

Permanent Address DR. SHODHAN RAO PEJAVAR S/o SUDHAKAR RAO PEJAVAR ‘VASANTHA VIHAR’ BEJAI POST, KADRI MANGALORE – 575004 KARNATAKA

2. Name of the Institute H.K.E SOCIETY’S MAHADEVAPPA RAMPURE MEDICAL COLLEGE, SEDAM ROAD, MAHADEVAPPA RAMPURE MARG, GULBARGA – 585105.

3. Course of the study and subject M.D. FORENSIC MEDICINE AND TOXICOLOGY

4. Date of admission to the course 30-05-2012

PATTERN AND DISTRIBUTION 5. Title of the Topic OF INJURIES IN FATAL ROAD TRAFFIC ACCIDENTS – A POSTMORTUM STUDY CONDUCTED IN BTGH, GULBARGA. 6. Brief resume of the intended work

6.1 Need for study

An accident has been defined as “an unexpected, unplanned occurrence which may involve injury”. A WHO advisory group in 1956 defined accidents as an “unpremeditated event resulting in recognizable damage”. According to another definition, an accident is that “occurrence in sequence of events which usually produces unintended injury, death or property damage”. Accidents represent a major epidemic of non-communicable disease in the present century. They are part of the price we pay for technological progress.1

Accidents are world’s most serious health problem. Man invented wheels accidentally and ever since then he has been doing accidents. Road traffic accident accounts for major epidemiological, medical and medico legal problem in developing countries like India. Road vehicles have no respect for anatomical boundaries or surgical specialties.

With increasing use of vehicles, injuries due to them are so common nowadays that it is necessary to be able to assess the injuries, the mechanisms by which they are caused, the cause of death, and if intoxication by alcohol or drugs played any part. The injuries often assume a definite and distinguishing pattern in the case of a pedestrian, and a driver or a passenger.2

Accidents constitute a complex phenomenon of multiple causation. There is a steep rise in vehicular accidents in present era due to urbanization and tremendous growth in road transport sector. Population explosion is a catalyzing factor for a number of accidents. The important human factors could be lack of adequate traffic planning and consumption of alcohol.3

Studies on fatal road traffic accidents are routinely carried out in developed countries. However very few studies on this topic have been carried out in India and in Karnataka state. The present study is undertaken with a view to investigate traffic accidents from all possible aspects such as pattern of injuries, distribution of injuries, cause of death and the type of trauma involved from postmortem findings so as to widen the knowledge of the medical faculty in the field of early diagnosis and management of such injuries and to suggest measures to be taken to decrease the rate of Road Traffic Accident incidence. 6.2 Review of literature:

Dr.Harnam et al (2004)3 conducted a study on 450 cases of fatal road traffic accidents. In this study pathological features of these cases as type of injury, pattern and distribution of injuries, body parts involved, fatal injuries and cause of deaths were noted at the actual autopsy examination of victim. The most common age group involved is 21-30 years and males outnumbered females in ratio of 9:1. Two third of cases are in age group of 11-40 years. Counted together extremity injuries outnumbered others (78.5%). Next were head and face 77.6%, chest 44%, abdomen 31.8% and neck 12.9% of all cases. Head injury was dominant in all road users (50.4%) followed by multiple injuries (15.8%) and thoraco-abdominal injuries (7.6%). 39.5% victims had succumbed within 1 hour, 2/3rd (67.8%) by 12 hours, 3/4th (77.1%) by 48 hours and 90% by one week and 97.7% within two weeks. The longest survival period was 30 days and 15 hours. Shock and haemorrhage was most common cause of death (36.9%) followed by intracranial hemorrhages (l9.6%) and severe brain injury (14.0%).

Dr. Harnam Singh et al (2007)4 analyzed the pattern of injuries sustained by 129 pedestrians in road traffic accidents. It was found that the pedestrians were the commonest group of victims involved in fatal road accidents comprising 28.7% of all cases. 83.7% cases were males. There were two peaks of incidence in relation to age; one at childhood (20.9%) and the other in elderly (19.37%). Cars and heavy vehicles were the commonest offending agents comprising 41.9% and 31.8% respectively. The pedestrians themselves were at fault in 43.4% cases. Head injury was seen in 80% cases; followed by lower limb fractures (42.6%), and chest injury (38.8%).The cause of death was head injury in 56.6% cases followed by thoraco-abdominal injuries in 8.5% cases and multiple injuries in 7.8% cases.

Khajuria B et al (2008)5 included 249 RTA victims in their study. One hundred and thirty two (53.01%) victims were between 20-40 years of age, males constituted 85.14% of the total victims, and light vehicles were involved in 61.05% RTAs. A total 609 type of injuries (organs involved) were reported in 249 victims. Limb injures constituted 189 (31.08%) of the total injuries, followed by injuries involving head, thorax, abdomen, pelvis and spine. Among head injuries, fractured skulls occurred in 68.85%, Subdural Haemorrhage in 79.31%, Subarachnoid Haemorrhage in 63.33%, Extradural Haemorrhage in 48.85%, Intra-cranial injuries in 21.26%, and Contusion in 35.63% of the victims. Head injury accounted for 173 (69.48%) of deaths, and haemorrhagic shock for 61 (24.49%) of deaths. Arvind Kumar MD et al (2008)6 aimed to study, pattern of injuries especially fatal traumatic brain injuries occurring in vehicular accidents and conducted autopsies on 2472 cases of vehicular accidents in their study. The male/female ratio was 7.49:1. Commonest age group affected was between 21-40 years involving 1341 (54.24%) cases. Fatal traumatic brain injuries were seen in 1699 (68.73%) cases. Skull fractures were found in 1183 (69.63%) cases of head injury; most common bone fractured was temporal bone (n=559, 47.25%). The commonest variety of intracranial hemorrhage was subdural hemorrhage (n=1514, 89.11%). The craniotomy was done in 297 (17.48%) cases; maximum mortality (41.07%) was seen within 4-14 days. Most commonly injured abdominal organ was liver (n=532, 21.52%).The results of study emphasize the need to improve the pre hospital care with provision of trauma services at site and to establish neurosurgical facilities with trauma registry.

Dr. K.K. Aggarwal et al (2009)7 study included 100 cases. Most common injuries were abrasions (86%) followed by lacerations (75%). and contusion (58%). Incised wounds were found in only 2% of cases. Most common site involved was head and face (85%) followed by lower limb (65%), upper limb (54%), chest (48%) and abdomen (36%). Head injury was the dominant cause of death (57%) followed by abdominal injuries (19%) and thoracic injuries (7%).

Dr. D. Rao et al (2010)8 analyzed on 254 cases both retrospective and prospective for 4 years. The cases consisted both fatal and non fatal, all the cases were analyzed for age, sex, nature and distribution of injuries sustained as a result of road traffic collisions. The major age group affected was 21-30 years (31.51%) and the least age group affected was between 61-70 years (1.97%). In majority of Cases Head and Face was affected [n-88 injuries-34.64%] and the least affected region of body was abdomen, (n-8; 03.5%). The males constituted to the majority of the collisions and the ratio of male: female was 5.4:1.

Dr. SS Oberoi et al (2011)9 conducted a study that included 50 cases of fatal two wheeler accidents details of which had been recorded to their pattern and distribution of injuries. According to the type of vehicles involved in these accidents, the maximum number of accidents was due to two wheeler vehicles which had the involvement of heavy and light four wheeler vehicles in the most road side accidents. As for regional injuries, head/face injuries dominated the cause of deaths in fatal accidents, followed by limb injuries. Maximum deaths occurred due to fracture injuries followed by abrasions, leading to haemorrhage.

S. V. Kuchewar et al (2012)10 conducted a study on 216 Road Traffic Accident cases. The cases were analyzed and data was collected regarding personal information, road factors, vehicle involved and fatal injuries. 50 % of fatal victims were in age group of 20-40 years, 87 % were males, 74 % married. Approximately 50% succumbed to head injuries, and mostly two wheelers were involved (40%). This burden can be simply overcome by enhancement of road safety knowledge among general public so that Road Traffic Accidents (RTA) can be prevented to great extent.

B. Suresh Kumar Shetty et al (2012)11 included 222 victims of fatal road traffic accidents in their study. A male preponderance (86%) was observed with a male-female ratio of 6:1. Individuals in the age group of 21 to 50 years formed the most vulnerable (83%) group. External thoracic injuries were more common than internal thoracic injuries in the thoracic region. In the abdominal region, internal injuries were more common than external injuries. Lungs (61%) and kidneys (23%) were the most commonly involved organs in the thoracic and abdominal regions respectively. Majority of the victims were two wheeler occupants (35%) followed by pedestrians (23%). The study indicates the pattern of thoraco-abdominal injuries sustained along with the trend of road traffic accidents in the region.

6.3 Objectives of the study:

 To study the various pattern of injuries and their distribution in Road Traffic Accidents.  To find out the duration of survival and cause of death.  To determine the age and sex incidence.  To suggest measures to reduce the incidence and number of deaths due to Road Traffic Accident.

7. Materials and Methods

7.1 Source of data :

All road traffic accident cases admitted and died in the Basaveshwara teaching and general Hospital, MRMC, Gulbarga. 7.2 Methods of collection of data:

1. Inquest report (Panchanama).

2. Hospital case reports.

3. Post Mortem findings.

Inclusion criteria:

 All road traffic accident cases admitted and died in the Basaveshwara Teaching and General Hospital, MRMC, Gulbarga. Exclusion criteria:

 All cases of deaths which are not due to road traffic accidents.

Place of study :

 Mortuary, Basaveshwara Teaching and General Hospital, Department of Forensic Medicine and Toxicology, MRMC, Gulbarga. Duration of study :

 The study is both retrospective and prospective for a period of 3 years from May 2011 to April 2014.

7.3 Does the study require any investigations or interventions to The study doesn’t require any be conducted on patients or other investigation to be done on humans humans or animals? If so please or other animals. describe briefly

7.4 Has ethical clearance been Yes, ethical clearance has been obtained from your institution in obtained from ethical committee of case of 7.3? M.R. Medical College, Gulbarga 8. List of references:

1) Park K. Park’s Textbook of Preventive and Social Medicine: 20th edition. Jabalpur: M/s Banarsidas Bhanot Publishers; 2009. 353. 2) Dr. C.K.Parikh. Parikh’s textbook of Medical jurisprudence, Forensic Medicine and Toxicology: 6th edition. New Delhi: CBS publishers and distributors; 2011. 4.132. 3) Dr. Harnam Singh, Dr. S.K.Dhattarwal. Pattern and distribution of injuries in fatal road traffic accidents in rohtak (Haryana). JIAFM. 2004; 26(1):20-23. 4) Dr. Harnam Singh, Dr. S.K. Dhattarwal, Dr. Shilekh Mittal, Dr. Akashdeep Aggarwal, Dr. Gauray Sharma, Dr. Rahul Chawla. A Review of Pedestrian Traffic Fatalities. JIAFM. 2007; 29(4): 55-59. 5) Khajuria B, Sharma R, Verma A. A profile of the autopsies of road traffic accident victims in Jammu. Journal of Clinical and Diagnostic Research. 2008 February; 2:639-642. 6) Arvind Kumar MD, Sanjeev Lalwani MD, Deepak Agrawal M Ch, Ravi Rautji MD, TD Dogra MD. Fatal road traffic accidents and their relationship with head injuries: An epidemiological survey of five years. Indian Journal of Neurotrauma (IJNT). 2008; Vol. 5, No. 2:63-67 7) Dr. K.K. Aggarwal, Dr. S.S. Oberoi, Dr. Rakesh Kumar, Dr. Manisha Sharma. Pattern and distribution of injuries in fatal road traffic accident cases. J Punjab Acad of Forensic Med & Toxicology 9 (2009); 72-75. 8) Dr. D. Rao, Dr.S. Mukerjee. A study of pattern of injuries in road traffic collisions. JPAFMT 10 (2010); 14-16. 9) Dr. SS Oberoi, Dr. HS Sandhu, Dr. KK Aggarwal, Dr. DS Bhullar. Pattern and distribution of injuries in fatal two wheeler accidental cases. J Punjab Acad Forensic Med Toxicol 2011; 11(1):31-33. 10) S. V. Kuchewar, R. D. Meshram and S. J. Gadge. Demographic Study and Medico-legal Aspect of Fatal Road Traffic Accident in Aurangabad. J Life Sci. 2012; 4(1):7-10. 11) B. Suresh Kumar Shetty, Tanuj Kanchan, Ritesh G. Menezes, Shankar M. Bakkannavar, Vinod C Nayak, K Yoganarasimha. Victim Profile and Pattern of Thoraco-Abdominal Injuries Sustained in Fatal Road Traffic Accidents. JIAFM. Jan- March 2012; Vol. 34, No. 1:17-20.

9. Signature of the candidate 10. Remarks of the Guide Accidents are most serious health problem all over the world. With increasing use of vehicles there is a steep rise in vehicular accidents. Gulbarga being a fast growing city, the incidence in number of accidents is increasing day by day. Better roads and vehicles made of better technology are the leading cause of fatal accidents. In the present day situation it is imperative to know the pattern and distribution of injuries caused due to these accidents.

DR.UMESH S.R M.D (FM&T) 11. Name and Designation of the PROFESSOR AND HEAD Guide (in block letters) DEPARTMENT OF FORENSIC MEDICINE AND TOXICOLOGY, M.R. MEDICAL COLLEGE, GULBARGA.

Signature of the guide

DR.UMESH S.R M.D (FM&T) Head of the Department PROFESSOR AND HEAD DEPARTMENT OF FORENSIC MEDICINE AND TOXICOLOGY, M.R. MEDICAL COLLEGE, GULBARGA.

Signature of the Head of the Department

12. Remarks of Chairman and Principal

Signature