Forensic characteristics of chest injuries among subjects who died in road traffic accidents

  • Živana S. Slović University of Kragujevac, Faculty of Medical Sciences, Department of Forensic Medicine, Kragujevac, Serbia
  • Katarina Vitošević University of Kragujevac, Faculty of Medical Sciences, Department of Forensic Medicine, Kragujevac, Serbia
  • Danijela Todorović University of Kragujevac, Faculty of Medical Sciences, Department of Genetics, Kragujevac, Serbia
  • Miloš Todorović University of Kragujevac, Faculty of Medical Sciences, Department of Forensic Medicine, Kragujevac, Serbia
Keywords: accidents, traffic, thoracic injuries, autopsy, cause of death

Abstract


Background/Aim. In road traffic accidents, chest injuries are a critical factor since death usually occurs as a result of injuries to the heart and lungs, flail chest, pneumothorax, exsanguination, etc. The aim of this study was to analyze the most vulnerable subjects in road accidents, as well as the most frequent and most significant types of chest injuries sustained by different categories of subjects, and to examine the relevance of certain injuries or factors to outliving the injuries. Methods. The autopsy, the retrospective, and the cross-sectional study were performed at the Clinical Centre of Kragujevac, Department of Forensic Medicine and Toxicology. The study included all participants in road traffic accidents on the territory of Kragujevac and the surrounding area who died from the injuries sustained from the accidents or due to complications of the injuries during the period from 2001 to 2016. The subjects were divided into the following groups: pedestrians, motor vehicle drivers, front-seat passengers, back-seat passengers, bicyclists, motorcyclists, and tractor drivers. The occurrence of injuries in three regions of the body (chest, head, and abdomen) was analyzed in all the subjects. Results. The study included 525 subjects who died due to the injuries sustained in traffic accidents, which makes up to 38.4% of the total number of 1,366 autopsy cases covered by the study period. The average age of the subjects was 52 ± 19 years. The study sample consisted of 391 (74.5%) men and 134 (25.5%) women. The most vulnerable subjects were pedestrians (220, i.e. 41.9%), followed by motor vehicle drivers (98, i.e. 18.7%), front-seat passengers (79, i.e. 15%), motorcyclists (39, i.e. 7.4%), bicyclists (38, i.e. 7.2%), back-seat passengers (29, i.e. 5.5%) and tractor drivers (22, i.e. 4.2%). Chest injuries were identified in 408 subjects (77.7%), while the most frequent type of injury was rib fracture, observed in two-thirds of the sample. Out of the total number, 291 (55.4%) subjects died at the scene of the accident or on their way to the hospital, while 234 (44.6%) of them outlived injuries for a certain period of time. Drivers exhibited the highest risk of dying at the scene, while bicyclists outlived their injuries more frequently. Conclusion. Chest injuries are very common in subjects who died at the scene of the road traffic accident.

References

World Health Organization. Global status report on road safety 2015. Geneva: World Health Organization; 2015.

O'Connor JV, Adamski J. The diagnosis and treatment of non-cardiac thoracic trauma. J R Army Med Corps 2010; 156(1): 5–14.

El-Menyar A, Abdelrahman H, Al-Hassani A, Ellabib M, Asim M, Zarour A, et al. Clinical Presentation and Time-Based Mor-tality in Patients With Chest Injuries Associated With Road Traffic Accidents. Arch Trauma Res 2016; 5(1): e31888.

Stewart DJ. Blunt chest trauma. J Trauma Nurs 2014; 21(6): 282‒4; quiz 285‒6.

Turkalj I, Petrović K, Stojanović S, Petrović D, Brakus A, Ristić J. Blunt chest trauma-an audit of injuries diagnosed by the MDCT examination. Vojnosanit Pregl 2014; 71(2): 161‒6.

Hemmati H, Kazemnezhad-Leili E, Mohtasham-Amiri Z, Darzi AA, Davoudi-Kiakalayeh A, Dehnadi-Moghaddam A, et al. Eval-uation of chest and abdominal injuries in trauma patients hos-pitalized in the surgery ward of poursina teaching hospital, guilan, iran. Arch Trauma Res 2013; 1(4): 161‒5.

Liman ST, Kuzucu A, Tastepe AI, Ulasan GN, Topcu S. Chest in-jury due to blunt trauma. Eur J Cardiothorac Surg 2003; 23(3): 374‒8.

Yeh DD, Kutcher ME, Knudson MM, Tang JF. Epidural analgesia for blunt thoracic injury–which patients benefit most? Injury 2012; 43(10): 1667–71.

Okutani D, Moriyama S, Ootsuka T, Niman E, Kashima H, Kuro-da M, еt al. Assessment of traumatic rib fractures caused by traffic accident. Kyobu Geka 2014; 67(5): 362‒5.

Stawicki SP, Grossman MD, Hoey BA, Miller DL, Reed JF 3rd. Rib fractures in the elderly: a marker of injury severity. J Am Geriatr Soc 2004; 52(5): 805‒8.

Swan KG Jr, Swan BC, Swan KG. Decelerational thoracic injury. J Trauma 2001; 51(5): 970‒4.

Cvetanović D, Stepić V, Stanić V, Kurtović Z. Injuries of the thor-ax. Vojnosanit Pregl 1991; 48(1): 23‒6. (Serbian)

Nikolić S. Forensic expertise of thoracic aorta, heart and peri-cardial injuries in car-occupant fatalities. Srp Arh Celok Lek 2009; 137(11‒12): 627‒31. (Serbian)

Nikolić S, Strajina V, Zivković V. The mechanism of injuring of front-seat passengers in head-on motor vehicle collisions: fo-rensic issues. Srp Arh Celok Lek 2013; 141(5‒6): 409‒14. (Serbian)

Daskal Y, Alfici R, Givon A, Peleg K, Olsha O, Kessel B, et al. Evaluation of differences in injury patterns according to seat position in trauma victims survived traffic accidents. Chin J Traumatol 2018; 21(5): 273‒6.

Pfeifer R, Schick S, Holzmann C, Graw M, Teuben M, Pape HC. Analysis of Injury and Mortality Patterns in Deceased Patients with Road Traffic Injuries: An Autopsy Study. World J Surg 2017; 41(12): 3111‒9.

Toro K, Hubay M, Sotonyi P, Keller E. Fatal traffic injuries among pedestrians, bicyclists and motor vehicle occupants. Forensic Sci Int 2005; 151(2‒3): 151‒6.

Farooqui JM, Chavan KD, Bangal RS, Syed MMA, Thacker PJ, Alam S, et al. Pattern of injury in fatal road traffic accidents in a rural area of western Maharashtra, India. Australas Med J 2013; 6(9): 476‒82.

Dirlik M, Bostancioglu BC, Elbek T, Korkmaz B, Callak Kallem F, Gun B. Features of the traffic accidents happened in the province of Aydin between 2005 and 2011. Ulus Travma Acil Derg 2014; 20(5): 353‒8.

Antunes SM, Cordeiro C, Teixeira HM. Analysis of fatal acci-dents with tractors in the Centre of Portugal: Ten years analy-sis. Forensic Sci Int 2018; 287: 74‒80.

Pinzke S, Nilsson K, Lundqvist P. Tractor accidents in Swedish traffic. Work 2012; 41(Suppl 1): 5317‒23.

Naci H, Chisholm D, Baker TD. Distribution of road traffic deaths by road user group: a global comparison. Inj Prev 2009; 15(1): 55‒9.

Sadeghi-Bazargani H, Samadirad B, Moslemi F. A decade of road traffic fatalities among the elderly in north-West Iran. BMC Public Health 2018; 18(1): 111.

Honnungar RS, Manipady S, Bastia BK. Cataract as the root cause of fatal road traffic accidents in pedestrians. Med Sci Law 2011; 51(2): 114‒5.

Reddy NB, Hanumantha, Madithati P, Reddy NN, Reddy CS. An epidemiological study on pattern of thoraco-abdominal inju-ries sustained in fatal road traffic accidents of Bangalore: Au-topsy-based study. J Emerg Trauma Shock 2014; 7(2): 116‒20.

Peymani P, Heydari ST, Hoseinzadeh A, Sarikhani Y, Hedjazi A, Zarenezhad M, et al. Epidemiological characteristics of fatal pedestrian accidents in Fars Province of Iran: a community-based survey. Chin J Traumatol. 2012; 15(5): 279‒83.

Zhao H, Huang W, Yang GY, Chen R, Liu SX, Yu YM, et al. Analysis of 86 fatal motorcycle frontal crashes in Chongqing, China. Chin J Traumatol 2012; 15(3): 170‒4.

Mirza FH, Hassan Q, Jajja Nadia. An autopsy-based study of death due to road traffic accidents in metropolis of Karachi. J Pak Med Assoc 2013; 63(2): 156‒60.

Shkrum JM, Ramsay AD. Forensic Pathology of Trauma: Common Problems for the Pathologist. Totowa, New Jersey: Humana Press Inc; 2007.

Liu W, Zhao H, Li K, Su S, Fan X, Yin Z. Study on pedestrian thorax injury in vehicle-to-pedestrian collisions using finite el-ement analysis. Chin J Traumatol 2015; 18(2): 74‒80.

Zhang G, Cao L, Hu J, Yang KH. A Field Data Analysis of Risk Factors Affecting the Injury Risks in Vehicle-To-Pedestrian Crashes. Ann Adv Automot Med 2008; 52: 199‒214.

Kibayashi K, Shimada R, Nakao K. Fatal traffic accidents and forensic medicine. IATSS Res 2014; 38(1): 71–6.

Ndiaye A, Chambost M, Chiron M. The fatal injuries of car driv-ers. Forensic Sci Int 2009; 184(1‒3): 21–7.

Ripple MG, Grant JR, Mealey J, Fowler DR. Evaluation of aor-tic injury in driver fatalities occurring in motor vehicle acci-dents in the State of Maryland for 2003 and 2004. Am J Fo-rensic Med Pathol 2008; 29(2): 123‒7.

Bamvita JM, Bergeron E, Lavoie A, Ratte S, Clas D. The impact of premorbid conditions on temporal pattern and location of adult blunt trauma hospital deaths. J Trauma 2007; 63(1): 135‒41.

Olds K, Byard RW, Langlois NE. Injury patterns and features of cycling fatalities in South Australia. J Forensic Leg Med 2015; 34: 99‒103.

Hitosugi M, Koseki T, Miyama G, Furukawa S, Morita S. Com-parison of the injury severity and medical history of disease-related versus trauma-related bicyclist fatalities. Leg Med (To-kyo) 2016; 18: 58‒61.

Kent R, Woods W, Bostrom O. Fatality risk and the presence of rib fractures. Ann Adv Automot Med 2008; 52: 73‒82.

Baldwin D, Chow KL, Mashbari H, Omi E, Lee JK. Case reports of atrial and pericardial rupture from blunt cardiac trauma. J Cardiothorac Surg 2018; 13(1): 71.

Almeida RL, Bezerra Filho JG, Braga JU, Magalhaes FB, Macedo MC, Silva KA. Man, road and vehicle: risk factors associated with the severity of traffic accidents. Rev Saude Publica 2013; 47(4): 718‒31.

Published
2021/03/18
Section
Original Paper