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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 8  |  Issue : 2  |  Page : 52-56

Road traffic accident fatalities and its association with key sociodemographic determinants in Nashik, Maharashtra: A recurring challenge


1 Department of Forensic Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra, India
2 Department of Community Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra, India

Date of Submission30-Nov-2021
Date of Decision16-Feb-2022
Date of Acceptance18-Apr-2022
Date of Web Publication28-Jun-2022

Correspondence Address:
Syed Meraj Ahmed
Department of Community Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422 003, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfsm.jfsm_84_21

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  Abstract 


Background: Road traffic accidents are not a new phenomenon, rather it's a disturbing occurrence which shows no sign of abating very soon. Rather, it remains one of those public health issues which even the most educated and civilized populations tend to ignore, primarily for the thrill of it. This study aims to identify the outcome associated with vehicular accidents and its association with socio-demographic factors. Method: This is a retrospective, record-based study of victims of road traffic accidents admitted in a tertiary care hospital in Nashik, Maharashtra. The data would include records from the 2018 to 2019. The variables will include the socio-demographic factors, site of injuries and its severity. A descriptive analysis would be done by SPSS software to find out the prevalence of vehicular accidents, association of site of injury with age and severity of the trauma. Ethical approval would be taken before the initiation of the study. Result: A total of 486 victims of RTAs were included from the medical records of the casualty of a tertiary care hospital, out of which 330 were from the year 2018 and 156 from 2019. A look at the sociodemographic profiles of the RTA victims showed that females comprised only 19.3% (2018) and 18.6% (2019) of the total victims in road traffic accidents, while majority, 80.6% (2018) and 81.4% (2019) were males during the same period. Overall, we can also observe that both in 2018 (38.5%) and 2019 (50.6%) most of the road traffic accidents among the victims were of moderate grade. Conclusion: The need of the hour is to bring about a change from within through self-reflection of lawmakers, strict implementation of traffic rules and guidelines with hefty fines, lockup, and criminal punishment to habitual wrongdoers.

Keywords: Age, facial trauma, gender, head trauma, multiple injuries, road traffic accident


How to cite this article:
Chhetri TB, Ahmed SM. Road traffic accident fatalities and its association with key sociodemographic determinants in Nashik, Maharashtra: A recurring challenge. J Forensic Sci Med 2022;8:52-6

How to cite this URL:
Chhetri TB, Ahmed SM. Road traffic accident fatalities and its association with key sociodemographic determinants in Nashik, Maharashtra: A recurring challenge. J Forensic Sci Med [serial online] 2022 [cited 2022 Aug 17];8:52-6. Available from: https://www.jfsmonline.com/text.asp?2022/8/2/52/348660




  Introduction Top


In a country like India, where the frequency of traffic accidents is one of the highest in the world, large variations in mortality across different regions will be minimal considering the average population density.[1] Sociodemographic factors are the benchmark for identifying the key risk areas that contribute to a high incidence of accidents and fatalities.[2] A study in South India found that male-to-female ratio was 6:1, and the age group of 21–50 years constituted 83% of all road traffic accidents (RTAs).[3] Furthermore, one study found that male aggression was the major contributing factor in a higher incidence of accidents as compared to females.[4] Zhang et al. mention in their study that the absence of streetlights contributes to fatigue-related severe crashes and a high fatality.[5] A study in Brazil (2016) elaborated on the higher vulnerability of motorcycle riders to RTAs compared to those in other types of vehicles.[6]

Sociodemographic determinants form an integral part of our search for a measurable comparison with an increasing RTA-related casualty admission. For this reason, factors such as young age group, breaking traffic rules, health disorders, mental state of mind, use of protective gear, error in judgment, and social and family problems, including momentary distractions (mobile use while driving), were taken into consideration. The specific factors associated with the vehicle such as overspeeding, changing lanes, overcrowding, and heavy traffic were also included to emphasize the environmental conditions. One study found that socioeconomic factors did not make any difference in the distribution of RTAs.[7] While another study in Georgia found that age, employment, and wealth status appeared to be strong independent predictors of RTA mortality among females.[8] Predictably, studies in India and neighboring countries have shown that high frequency of accidents and mortality was associated with a younger age victims as compared to elder drivers.[9],[10],[11]

This leads to an important and arguably the most agreed issue of the impact that RTAs cause to individuals, families, and communities. A study on the financial impact of RTA points out that there is an immense loss to all persons involved both in short-and long-term analysis.[12] Another study in Spain pointed out that governments and policy-makers need to strengthen road accident preventive measures to reduce the high socioeconomic costs.[13]

A recent search on the web for any RTAs associated with sociodemographic variability in Nashik did not bring any results. It was felt that due to an evolving population and the rapid pace of technology that brings speed and thrill in vehicular experience, an exploratory study is required on RTAs. Our research question explores the sociodemographic variables where the accidents occur the most and those who are primarily vulnerable to it.

Objective

  1. To study the association of RTAs with sociodemographic factors among the participants
  2. To identify the risk factors associated with increasing severity of RTA among the participants
  3. To give recommendations on the probable approach that could optimally minimize the occurrence of RTAs among the vulnerable population.



  Methodology Top


Study design

This study was a retrospective, cross-sectional, and observational study.

Study setting

Patients admitted to the trauma ward of the casualty of a tertiary care center in Nashik due to RTAs in the past 1 year.

Study participants

All the patients in the records with chief complaints of RTAs and admitted through the casualty.

Study duration

The study duration was 6 months from the date of approval from the Ethics Committee.

Sample size

All the patients in the medical records with complaints of RTAs during the study period were included in the study.

Sampling technique

A total enumeration of all the patients' records admitted with complaints of RTAs in the casualty in a tertiary care hospital, Nashik, from 2018 to 2019.

Data collection

Data were collected from the medical records of the patients admitted with complaints of RTAs within 2018–2019.

Data analysis

All the relevant data would be entered in the statistical software IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. and analyzed. All the quantitative data were statistically analyzed, and descriptive analysis of the results was displayed.

Ethical approval

This study has obtained prior approval from the Institutional Ethics Committee on 14/05/2020 with approval no. Dr. VPMCH and RC/IEC/04/2019–20.


  Results Top


A total of 486 victims of RTAs were included from the medical records of the casualty of a tertiary care hospital, out of which 330 were from 2018 and 156 from 2019. A look at the sociodemographic profiles of the RTA victims showed that females comprised only 19.3% (2018) and 18.6% (2019) of the total victims in RTAs, whereas majority, 80.6% (2018) and 81.4% (2019), were males during the same period.

[Figure 1] shows the distribution of the age group among male and female victims during the study period, and it shows a wide variation in the range in certain age groups. Among the female gender, there is a moderate decline among RTA victims (21–40 years) from 10.0% in 2018 to7.1% in 2019. Whereas, apart from a negligible increase of female victims among the age group of <20 years, there is a significant increase from 3.9% to 7.1% in the 41–60 years and a drop of 2.4%–1.9% in the >60 years age group. Comparatively, among male victims of RTAs, it was seen that there was a minimal downward shift in the numbers of victims from 44.8% in 2018 to 43.6% in 2019.
Figure 1: Distribution of the sample population as per age and gender. RTA: Road traffic accidents

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[Table 1] shows the distribution of accident severity among different age group victims. It is seen that most of the accidents have occurred in the 21–40 years' age group and having larger distribution in the severe grade (21.8% in 2018 and 10.3% in 2019) in both the years. Overall, we can also observe that both in 2018 (38.5%) and 2019 (50.6%), most of the RTAs among victims were of moderate grade. Very fewer victims (8.2% in 2018 and 5.8% in 2019) were in the elderly age group (>60 years old). It is seen that among the age group of 41–60 years RTA victims, more numbers were involved in 2018 (20.6%) as compared to 2019 (24.4%)
Table 1: Distribution of road traffic accidents severity with age group

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[Table 2] shows the distribution of anatomical site of injury to the severity scale as per the Abbreviated Injury Scale (AIS).[14] Overall, in 2018, the severity of injury was higher (level 3%–37.3%) as compared to 2019 (level 2%–39.7%). The level of severity among head trauma victims was higher in all categories as compared to injury to other anatomical parts of the body. Comparatively, Grade 3 severity among head trauma victims was higher (24.5%) in 2018, whereas it was Grade 2 (30.1%) in 2019. Furthermore, the critical level of severity (Grade 5) was higher in 2018 (6.4%) as compared to 2019 (3.8%). On comparison of facial trauma victims, it is seen that a greater number of patients suffered in all levels of severity in 2019 than in 2018. Even among victims of multiple injuries, Grade 2 category was higher (3.8%) in 2019 as compared to 2018 (2.7%). Abdominal trauma patients had the least severity on an average in all categories in both the years (2018 and 2019)
Table 2: Distribution of injuries according to the Abbreviated Injury Scale

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[Table 3] shows the distribution of area of injury on the human body with the severity after the RTAs among victims. In 2018, most of the RTA injuries were associated with trauma to the head (73.3%), followed by multiple injuries (13.3%), chest trauma (7.58%), facial trauma (5.15%), and a miniscule percentage had abdominal trauma (0.61%). In 2019, majority of the victims had sustained head trauma (65.4%), followed by facial trauma (17.9%), multiple injuries (11.5%), chest trauma (3.8%), and abdominal trauma (1.3%). It is observed that in 2018, majority of the victims had severe head trauma (29.7%) closely followed by victims with moderately severe trauma to the head (27.58%). Comparatively, in 2019, we see that most of the victims had moderate trauma (34.6%) and fewer had severe trauma (12.2%) to the head, which shows a distinct decrease. Again, severe multiple injuries were higher in 2018 (6.67%) as compared to 2019 (3.2%). Overall, the severe multiple injuries due to RTAs in 2018 (42.12%) were much higher than in 2019 (23.7%).
Table 3: Distribution of injuries severity and category among the participants

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  Discussion Top


The purpose of this study has been to enhance the quality of information related to injuries due to RTAs and its demographic distribution. Even with better roads, infrastructure, and health information for drivers, there is also a need to monitor the prevalence of RTAs to develop better plans of safety on the road. Our study shows that 21–40 years age group is the most vulnerable with the highest percentage of accidents (2018‒54.8% and 2019‒50.6%) as compared to other age groups. Next is the 41–60 years age group (2018–20.6% and 2019–24.4%) which is having a high percentage of RTAs. Furthermore, as seen in [Figure 1], males were more likely to be involved in accidents than females. A study in India (2017) similarly published that 30–59 years age group is the most vulnerable, and males are more likely to be involved in RTAs.[15] Another study from Bangladesh reported that 15–44 years age group are the most vulnerable, and males accounted for 73% of the mortality in RTAs.[16] A study in Delhi analyzed 3 years of data to conclude that among others, gender, vehicle speed, and traffic volume were significantly associated with the risk of RTAs.[17]

AIS is an internationally recognized scoring system for a variety of traumatic injuries since its beginnings as a marker used for tracking injuries in automotive and aircraft mishaps.[18] In our study, we see that head injury victims have a higher severity score in all grades than injuries to other parts of the body. A study on severity risks of specific injuries due to RTA found that head injuries were associated with a score of AIS 2+.[19] Our study showed that compared to the injury to other anatomical parts of the body, head injury carried a higher AIS grade even till level 5 (2018–6.4% and 2019–3.8%). A similar study on motor vehicular accidents involving drivers found that head injury victims scored 3+ in the AIS grading.[20] In our study, victims of abdominal trauma were very few, but among those who received the injury the AIS score was 3+ in both 2018 and 2019. Similarly, a study involving abdominopelvic injuries due to RTAs showed that injury score was in the range of four and five.[21]

In this study, it is seen that head injury constitutes most RTAs both in 2018 (73.3%) and 2019 (65.4%). A similar study reported that nonhelmet-wearing riders have a four times higher risk of head injuries in a vehicular accident.[22] Our study showed that there was a steep increase in facial injuries from 2018 (5.2%) to 2019 (17.9%). A 12-year retrospective study in Gujarat found that maxillofacial injuries are the most common in RTAs in developing countries.[23] Other studies have also pointed out that riders without helmets and those with helmets who sustained visor damage were most likely to suffer from trauma to the face during a vehicular accident.[24],[25] In this study, we also found that multiple injuries due to RTA were 13.3% (2018) and 11.5% (2019), respectively, in which most of the fatalities were in the 21–40 years age group in both 2018 (7.9%) and 2019 (5.1%). A descriptive study in China (2017) stated that multiple injuries constituted 40.6% of the total injuries recorded which was way higher than our findings.[26] A study in the Netherlands found a high incidence of multiple traumas, cerebral hemorrhage, and fractures among bicycle victims of RTA.[27] A worldwide collaborative review article has grim predictions for India which has already overtaken China as the RTAs capital of the world, saying that it would most likely cross the mark of 250,000 within the next 4 years.[28] A similar exploratory study in Bihar concluded that the occurrence of accident is independent of age and sex distribution, but the severity of injuries are seen more in the third and fourth decades of life.[29]


  Conclusion Top


This study questions the reasons or lack thereof as far as increasing RTAs are concerned in the present India. The burgeoning middle-class population and the availability of vehicles in all forms and sizes exponentially increase the probability of accidents on the road. Combine this with a lack of education, awareness, belligerence, substance of influence, lawlessness, and exposure to a gargantuan social media with its thrills and chills, we are looking at a chasm of impossibilities. The need of the hour is to bring about a change from within through self-reflection of lawmakers, strict implementation of traffic rules and guidelines with hefty fines, lockup, and criminal punishment to habitual wrongdoers. More than that, a vigorous campaign through social media, banners, advertisements, school health programs, village skit plays, movies, dramas, Panchayat meetings, etc., to bring about a broad awareness about safety against RTAs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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