Pattern of Morbidity and Mortality due to Road Traffic Accident Cases at BPKoirala Institute of Health Sciences, Dharan

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Pattern of Morbidity and Mortality due to Road Traffic Accident Cases at BPKoirala Institute of Health Sciences, Dharan
Pattern of Morbidity and Mortality due to Road Traffic Accident Cases at BPKoirala Institute of Health... trauma are major health problems and are frequent causes of death among RTA victims.³ The Abbreviated Injury Scale (AIS) is an anatomically based, consensus derived, global severity scoring system that classifies an individual injury by body region according to its relative severity on a 6 point scale. 4 Abbreviated Injury Scale (AIS), has subsequently been applied to large series of traffic accidents by 5 to traffic and non-traffic accidents by6and to multiple traumatized patients by. 7 In 1974 Baker et al developed the concept of a whole body score or Injury Severity Score (ISS), derived from the three highest individual AIS scores in different body regions. 8 To calculate the ISS from an array of AIS scores for a patient, the three highest AIS scores in different body regions are squared then added together. ISS considers the body to comprise six regions as follows: 1. Head/neck 2. Face 3. Chest 4. Abdominal or pelvic contents 5. Extremities or pelvic girdle, 6. External (skin). In forensic casework, investigation of injury severity is important for evaluating the mortality, occasionally in terms of the adequacy of clinical management. For this purpose, the abbreviated injury scale (AIS) and injury severity score (ISS) for anatomical evaluation are widely used in both forensic and clinical medicine. 9 The study of injuries from morbidity cases and the autopsy cases can be helpful to widen the knowledge ofthe medical faculty in the field of early diagnosis and management.
The objective of the study was to assess the morbidity and mortality patterns among RTA victims at BPKIHS, Dharan and to assess injuries pattern among RTA victims as per extent, severity, nature and type of injuries in different region of the body in our local setting and provide baseline data for establishment of prevention strategies as well as better management.

METHODS:
A descriptive cross sectional study was conducted on 348 cases taken from Emergency department and the Department of Forensic Medicine and Toxicology at B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan. Ethical clearance was taken from the Institutional Ethical Committee of B.P. Koirala Institute of Health Sciences.
The study was conducted during a period of one year by using convenient sampling technique. All the injured cases and autopsies regarding RTA were included in this study and the bodies that were decomposed were excluded from the study. The sample size was calculated based on a research done by Choulagai B. Pet al.10which shows prevalence of death among RTA cases was 23.3%. Taking proportion, p= 23.3%, q= compliment of P and permissible error of 10%. Using formula, n = Z²P (100−q)/ L² = (1.96)² x23.3x(100−23.3)/(20% of 23.3)² the sample size was calculated as 316.1. Then, adding 10% for non-response, it came to be 348 victims. Data was collected using semi-structured questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) 11.5.
The informed consent was taken from the injured ones and were examined.The dead patients had anautopsy done on them. The relevant information was taken from inquest paper and police, relatives, neighbors, friends or other persons accompanying the dead body. The bodies that were decomposed were excluded from the study.Injury Severity Score(ISS) was used to assess the severity of injuries RESULTS:

SOCIO-DEMOGRAPHIC VARIABLES
Among the total Road traffic accident victims presenting to BPKIHS, Dharan, 348 were studied. The morbidity pattern was studied among 318 cases and the mortality pattern was studied among 30 cases which were autopsied (        Students and service holder were the most injured because of the rush through heavy traffic to get to their occupation and to the school. Similar observation was noted in the previous study by others. 12 Students are usually involved in road traffic crashes as they rush through heavy traffic to and from their schools. These school-age group children are usually very active and are often less supervised.
The study showed that most of the RTA was two wheelers accident. Motorcycle has become one of the most popular vehicle in Nepal as it is inexpensive, easy available and accessible to the people. As motorcycles are relatively unsafe vehicles, the riders must be considered as unprotected vehicle users and their injuries are usually severe.
Our study showed that maximum number of accident occurred during day and night time in comparison to morning time. The maximum accidents occurred between 12 pm to 3 pm or 6 pm to 9 pm in a study done in Dharan, eastern Nepal which supports our study result. 13 Increased rate of injuries during the day can be explained by increased traffic jams as well as increased human activities in the city during the day time. Knowing the time of injury in trauma patient is important for prevention strategies.
In the present study 57.7% road traffic crash victims were found to have the habit of smoking and alcohol consumption. The NMJ I VOL 03 I NO. 02 I ISSUE 05 I Jul-Dec, 2020 Pattern of Morbidity and Mortality due to Road Traffic Accident Cases at BPKoirala Institute of Health... role of alcohol in impairing driving ability is well documented. Alcohol usage causes carelessness and loss of concentration as well as over speeding and neglecting to use safety equipment such as helmet. The data regarding consumption of alcohol prior to the accident were not adequate which the limitation of our study.
In our study, we found abrasion (61.2%) to be the most common injury occurred during the RTA followed by laceration (34.1%), fracture (20.9%), Blunt Trauma Abdomen and Chest (12%). Our study result is supported by study done at College of Medical Sciences, Chitwan, Nepal which reports that maximum injury found was abrasion (91%) followed by laceration (64%). 14 Median ISS for mortality cases was 31.50 and for morbidity cases was 1. Median ISS for mortality cases was found to be significantly high as compared to that of morbidity cases.

CONCLUSION
Road traffic accident is one of the major causes of morbidity and mortality. Injuries in various body regions are frequent findings in victims of RTA. Our study showed that median ISS of mortality cases was significantly high compared to that of morbidity cases.
Surprisingly, in developing country like ours where transportation facilities and expert doctors are not readily available some died on their way to hospital while others died after being treated even at the minimum ISS of 10. Proper examination and investigation play major role in management of the patient and could be lifesaving. Autopsy examination has proved its very importance in finding the exact cause of death and relationship between various injuries time and again.