|Year : 2021 | Volume
| Issue : 2 | Page : 319-324
An epidemiological study on road traffic accidents at a tertiary care hospital of Eastern India
Sumita Sharma, Lipilekha Patnaik, Sambedana Mohanty, Trilochan Sahu
Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha “O” Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
|Date of Submission||04-Aug-2020|
|Date of Decision||18-Oct-2020|
|Date of Acceptance||15-Jan-2021|
|Date of Web Publication||18-Oct-2021|
Dr. Lipilekha Patnaik
Department of Community Medicine, Institute of Medical Sciences and SUM Hospital, Siksha “O” Anusandhan Deemed to be University, Kalinga Nagar, Ghatikia, Khordha, Bhubaneswar - 751 003, Odisha
Source of Support: None, Conflict of Interest: None
Introduction: Accidents and injuries are the leading cause of morbidity and mortality. According to the World Health Organization, 1.35 million deaths occurred due to road traffic accident (RTA) globally in every year. In India, fatality rate of road accidents is twenty times higher than developed countries. Objectives: The objective of this study is to assess the epidemiological factors responsible for RTA and to know the pattern of accidents. Materials and Methods: A hospital-based, cross-sectional study was conducted among RTA victims admitted at a tertiary care hospital of Odisha from August to November 2019. The data were collected by using predesigned and pretested interview schedule and analyzed with the help of SPSS 20. Results: Out of 147 accident victims, 81% were male; mean age was 36.6 ± 13.67 years. Maximum accidents (43.5%) had taken place between 11 a.m. and 5 p.m. Bike-riders (81.6%) were the major victim involved in accidents followed by pedestrian (9.5%) and cyclist (8.9%). Among bike riders, 44.16% did not wear helmet during accident and 3.33% did not have a valid driving license. About 25.2% were due to alcohol intake. Unusual behavior of animals and defective road contributed around 10.2% and 16.90%, respectively. Among injuries, the most common was laceration (38.1%) followed by abrasion (22.4%). Fracture was found in 7.5% cases. Most common sites involved were head, face, upper limb, and lower limb. Conclusion: Public awareness should be initiated regarding various factors associated with RTA and measures to prevent accidents.
Keywords: Accident victims, accidents, road traffic accident
|How to cite this article:|
Sharma S, Patnaik L, Mohanty S, Sahu T. An epidemiological study on road traffic accidents at a tertiary care hospital of Eastern India. J Datta Meghe Inst Med Sci Univ 2021;16:319-24
|How to cite this URL:|
Sharma S, Patnaik L, Mohanty S, Sahu T. An epidemiological study on road traffic accidents at a tertiary care hospital of Eastern India. J Datta Meghe Inst Med Sci Univ [serial online] 2021 [cited 2021 Dec 9];16:319-24. Available from: http://www.journaldmims.com/text.asp?2021/16/2/319/328463
| Introduction|| |
A road traffic accident (RTA) is any injury originating from terminating with or involving a vehicle partially or fully on a public road. It is an event that occurs on a way or street open to public traffic; resulting in one or more persons being injured or killed, where at least one moving vehicle is involved. According to the World health Organization (WHO), RTA results approximately 1.35 million deaths around the world every year. Globally, India is ranked first in road deaths. In India, fatality rate of RTAs are twenty times higher than developed countries. Expansion in road network, increase in number of vehicles, and urbanization in the country have been contributed to rise in road accidents in India. According to the Registrar General of India, accidents and injuries account for 17% of disability-adjusted life-year losses in the country. According to WHO predictions, if a concerted effort is not made to improve the services by 2020, there will be 14.7% increase in RTA deaths in India. India has 1% of the world's vehicles, but 6% of the total global RTA deaths. Economic loss amounts to 550 crores (12.5 billion dollars), an amount that equals our defence budget.
Evidence shows that with an established set of interventions, road traffic injuries have been reduced in many high-income countries since the 1960s and 1970s. However, the road traffic death rates in low-income and middle-income countries have increased substantially. The association in between epidemiological risk factors with RTA in Indian cities was explained by many studies.,, In most of the cases, road accidents are caused by human errors. Drunk driving has a high probability to lead road accidents among the human errors. Even with a small amount of alcohol consumption, drivers are twice likely to be involved in traffic injuries than nonalcoholic drivers. In a study by Kar S et al. reported that the incidence of vehicular accidents for Bhubaneswar city was 9.07/10,000 population in 2012. In that study, they showed that grievous injury accounted to 38% of the total while fatality due to RTA was nearly 30%. Hence, RTA is an issue of national as well as local concern. It has high impacts on the economy, public health, and the general welfare of the people. This study was planned to assess the epidemiological factors responsible for RTA as well as to know the pattern of accidents in various places of Odisha which are reported in a tertiary care hospital of Odisha.
| Materials and Methods|| |
This was a cross-sectional study, RTA cases which were reported in casualty of a tertiary care hospital during the period of August to November of 2019 were included. The sample consisted of 147 victims. Universal sampling method was used in the study. Victims who did not give consent to participate were excluded. Written informed consent was taken from the victims or informants. A predesigned and pretested schedule consisting of sociodemographic profile, pattern of injury, and factors responsible for accident was collected. Data collected were entered into Excel Spreadsheet. Appropriate statistical analysis was done using SPSS software version 20.0.
The operational definition of RTA for this study was “An event that occurs on a way or street open to public traffic; resulting in one or more persons being injured or killed, where at least one moving vehicle is involved. Thus RTA is a collision between vehicles; between vehicles and pedestrians; between vehicles and animals; or between vehicles and geographical or architectural obstacles.” The determinants for RTAs were further categorised into human factor, vehicle factor, and environmental factor. Here Human factor includes excessive speed limit, not having driving license, not using indicators, overtaking other vehicles, not following traffic rules, alcohol consumption during driving, inadequate sleep before riding, having medical illness, use of mobile phones during driving and presence of stress among victims. Whereas the vehicle factor includes damaged headlight, poorly maintained vehicle, and overloaded vehicle. The environmental factor includes poorly maintained road, inadequate street light, unusual behavior of animal, and bad weather condition.
| Results|| |
A total of 147 cases of RTA formed the study population. There were 81% male and 19% female victims. The mean age affected by RTA was 36.67 ± 13.67 years. Maximum number 54.7% of male victims and 35.7% of female victims were in the age group of 26–45 years. The highest number 51.1% of victims was between 26 and 45 years of age followed by 22.4% victims in the age group of 18–25 years and 17.0% were above 45 years of age. There were 14 (9.5%) cases of younger people under 18 years of age. Hindus dominated the study population, i.e., 97.27% and 2.72% were from other religions such as Muslim community and Christian society. Most of the cases were from joint family, i.e., 92.51%. RTA cases from urban and rural areas were 83.67% and 16.32%, respectively. High prevalence of RTA was reported in below graduate people, i.e., 73.40% followed by 19.0% had an educational status of graduate and above. As per modified B. G Prasad scale people belonging to lower socioeconomic class were affected more 41.40% followed by middle class (36.70%) and upper class (21.80%) [Table 1] and [Table 2].
Around 57.1% were directly reported to the hospital and 42.9% were referred cases. In this study, it was observed that 81.6% of the total 147 RTA victims were bike rider followed by 9.5% were pedestrians and 8.9% were in cycles. Among the total 120 bike riders, 3.33% victims did not have driving license and 2.5% did not use indicator during driving. Helmet was not used among 44.16% of bike-riders. Among the total cases of both bike-riders and cyclists, i.e., among 133 victims, 24.5% had tried to overtake other vehicles. Out of all victims, 74.14% had followed the traffic rule properly, whereas 25.85% cases did not obey the traffic rule. It was seen that, evidence of alcohol was recorded in 25.2 of victims while 74.8% did not have it. It was observed that, 29.4% of male victims and 7.1% of female victims showed evidence of alcohol. There was a significant difference between the consumption of alcohol by male and female (χ2 = 5.968, P = 0.01, odds ratio [OR] = 5.41).
History of inadequate sleep before driving due to various personal problems such as deviance, hyperactivity, low tolerance, and inattentiveness was found in 12.2% cases. In this study, 17.7% victims among the total had struggled with stress in their personal life. Out of the total study population, 6.8% were hypertensives, 4.7% were diabetics, and a single case of asthma as per their drug history. It was seen that 5.4% victims had blurring vision problem. This study showed that 10.2% cases among the total study population had used mobile phones during the time of accidents.
The RTAs were divided into five slots, i.e., morning (5.00 a.m.–11.00 a.m.), day time (11.00 a.m.–5.00 p.m.), evening (5.00 p.m.–7.00 p.m.), night (7.00 p.m.–10.00 p.m.), and at last late night (10.00 p.m.–5.00 a.m.). It was seen that maximum (43.5%) of the RTAs occurred in the day time, i.e., in between 11 a.m. and 5 p.m. and the minimum (3.4%) occurred in the late night [Figure 1].
Rainfall is consistently cited as the weather type responsible for the greatest number of weather-related accidents in road. It was seen that 17.7% accidents happened during rainfall, 6.1% happened in a foggy environment, and 4.1% cases happened in a smoky day. RTA was more on national highways, i.e., 89.8% and 6.1% and 4.1% were in hilly road and narrow city urban roads, respectively. The occurrence of RTA was maximum around 82.3% in crowded places, whereas 17.7% cases occurred in lonely places. In this study, 17% RTAs occurred in poorly maintained road which was caused by breakage of pavement due to heavy rainfall and depressions, rutting, ravelling of road due to incomplete construction. There was no adequate street light in 4.8% RTAs. Among the total cases 10.2% were due to unusual behavior of stray animals.
The study revealed 19% cases of RTAs involved victim's vehicle, 8.2% involved vehicle of other person, and around 69.4% cases of RTAs involved both vehicle of victim and accused. Speed of the vehicle was categorized into six groups as described in the study by Pathak et al. The mean speed of vehicle of the victims during the accident was 50.71 ± 26.99 km/h by excluding those who could not tell the speed of their vehicle and 14 pedestrians. There were 3% cases of RTAs having speed <20 km/h, 12.78% cases with speed 20 km/h–40 km/h, 53.38% cases with speed of 40 km/h–60 km/h, 9.77% RTAs with speed of 60 km/h–80 km/h, 14.28% cases of RTAs having speed more than 80 km/h, and 6.76% cases were not able to tell the speed of the vehicle at time of accident [Figure 2]. There were 6.8% cases of RTAs among the total occurred due to poor maintenance of the vehicle and 12.2% cases revealed with overloaded vehicle as the cause of accidents.
|Figure 2: Speed of vehicle at the time of accident (*14 pedestrians have been excluded in this data)|
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It was observed that, 38.1% victims had lacerated wound, 22.4% had abrasion, 2% had haemorrhage, 2% had avulsion, 1.4% had perforation, 7.5% had fracture, and 26.5% had multiple injury which was comprised of either laceration or abrasion simultaneously or fracture and abrasion or fracture and laceration or hemorrhage and abrasion simultaneously [Figure 3]. Among all, 45.6% had multiple site injuries those who had injury on head and any of the limb, 19.0% had strictly injured by the lower limb, 16.3%% had injuries of head and face, 15.6% had injury on the upper limb and only 3.4% had injury on the thorax and abdomen [Table 3].
|Table 3: Distribution of road traffic accidents cases as per the type of injuries|
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Head on collision was 25.9%, whereas maximum RTAs occurred with sideways collision, i.e., 63.3% and 9.5% victims faced collision from behind. Only 2 (1.4%) cases had not fronted any type of collision.
According to the version of victims and their relatives, it was estimated that maximum RTAs 36.10% were due to not wearing helmet, 36.1% were due to disobeying traffic rule, 30.6% were due to bad weather, 25.2% were due to excessive alcohol consumption during driving, 17.7% were due to the presence of stress and upset in the personal life of the victim, 16.9% were due to defective road, 12.2% were just because of overloaded vehicle, 12.2% were due to inadequate sleep before riding, 10.2% were due to unusual behavior of stray animals, 10.2% due to using mobile phones during driving by victims, 8.2% due to blurring vision of victims, 6.8% were due to poorly maintained vehicle, and 4.8% were due to the absence of adequate light in the roads [Figure 4]. Among all RTAs, 33.34% were due to human factor, which was followed by both human and environmental factor (17.68%) and 15.65% were involved by all the three factors, i.e., human, vehicle, and environmental factors. 12.24% were due to both human and vehicle factor, 9.53% were due to both vehicle and environmental factors, 11 7.48% were due to only environmental factor and 4.08% were due to only vehicle factor.
It was observed that 19.7% victims developed disability due to accident and 4.8% developed organ dysfunction and one male succumbed to death.
| Discussion|| |
The maximum of RTA victims (51.1%) was found between the age group of 26–45 years; similar result was found in the study conducted by Sehat et al. which was also depicted with majority of accidents 39.9% occurred in 26–45 years of age group followed by 39.7% RTAs in between 18 and 25 years of age group and 20.34% victims were of age above 45 years. Whereas Hassan N had found, the age group most commonly involved were 20–29 years. The people among age group of the third decade were most commonly involved in RTAs. This study found that 73.5% of the victims were in the age group between 18 and 45 years. This shows that the people of the most active and productive age group are involved in RTAs, which adds a serious economic loss to their families and community as well. The present study showed that the proportion of accidents was low in persons below the age of 18 years, which may be attributed to that the children were taken care of by elders and they were not getting driving license before 18 years. Lower proportion of RTAs in the age of 45 and above could be due to the experience and carefulness in driving in their age group. According to this study, the accident rates were 4.25 times higher in males than in females. This was also observed in the study conducted by Biswas et al. in North-east Delhi, which has reported very high male and female ratio (9:1). There were 83% male and 17% female victims involved in another study carried out by Chourasia et al. at PGIMER, Pondicherry. It was found that most of the people involved in RTA had educational status of 7th to 10th class. There may be the lack of awareness regarding road safety among those low level educational set up. In contrast to this another study by Sami et al. resulted with uneducated people (including the children <7 years who have not attended school) have a mortality rate of 26.2% which was the highest among all educational level. Road traffic injury is one area that is not well understood with respect to socioeconomic determinants, especially in developing countries. The identification of socioeconomic gradients in risk for injury through a descriptive study may provide opportunities for targeting of preventive interventions to high-risk groups. Here, the study revealed lower class SES and upper class SES had involved more, i.e., 22.40% and 21.80%, respectively. Another study conducted in West Bengal shows evidence of 56.3% RTA cases were from lower socioeconomic status.
It has been observed that deaths and injury were mainly due to not wearing helmet (36.10%). Similar study by Kim et al. showed that the helmeted group was less likely to have an intracranial injury compared with the un-helmeted group (41.0% vs. 54.6%, AOR: 0.53 (0.33–0.84)).
There has been found maximum cases of RTAs in bike-riders as compared to pedestrians and other vehicles. Similar study by Pathak et al. shown that motorized two-wheeler was the most common vehicle involved (71.9%) in the accident. Pedestrians included the next commonest category, but another study by Kiran, it was observed that 97 (60.2%) of the total RTA victims were pedestrians, 38 (23.6%) were those who were driving two-wheelers, and 26 (16.2%) were those driving four-wheelers out of the total 161 (100%) cases.
This study had evidence of most of RTAs in the day time (11 a.m.–5 p.m.). It can be explained as maximum mobilization of people during this time leads to maximum occurrence of accidents. Previous study by Bakhtiyari et al. Maximum number of accidents occurred in between 3 p.m. and 7 p.m., i.e., 44.16% followed by 24.16% between 7 a.m. and 11 a.m. Mortality wise highest number of cases was found between 3 p.m. and 11 p.m. at a percentage of 72.72%. A study by Kar et al. also resulted with maximum occurrence of RTAs in between 6 a.m. and 12 p.m.
The effect of alcohol among drivers is that it basically affects drivers' physiological characteristics and then affects external performances. It is the fundamental reason of the impairment of driving skill. The statistical results of the questionnaire showed that most of the participants (25.20%) was affected by excessive intake of alcohol. A Chinese study by Zhao et al. explained that under the influence of alcohol, drivers exhibited the characteristics of being imbalance, impulsive, sensation seeking, adventurous, and moving faster. At the same time, the ability of judgment, recognition, reaction, and operation were impaired. Therefore, drink driving will produce a high probability to serious accidents. Probability of getting accidents was more in those victims who were not well trained or not having valid driving license. The present study ensued with 3.33% victims among bike-riders didn't have valid driving license. Another study carried out by Moafian et al. described with similar findings 0.97% drivers were found to be not having valid driving license. Similar study conducted by Jha et al. found also ensued that out of 254 drivers involved in road accidents 33.46% were driving bike and among those bike riders 15.3% had no valid license.
In this study, 17.7% victims were in stress during driving. A conducted by Amini et al. showed life stresses (family arguments, financial problems, occupational problems, and night shifts), and stresses while driving (angry reactions during driving, fear of possible damage during driving, and poor road conditions) have a significant difference between the two groups (P = 0.05), such that the odds of road accidents caused by lifestyle stress in the case group were about three times more than the control group (P = 0.001, OR = 2.958, 95% confidence interval = 1.66–5.26).
There were 10.2% of victims using mobile phones while the accidents happened. The study conducted by Alghnam et al. explained distraction from driving is an emerging threat to traffic safety. There are many forms of distraction, including visual, manual, auditory, or cognitive. There is an increased risk of RTAs due to distracted driving associated with mobile phone use.,, In India, around 31% of the RTAs could be attributed to the use of mobile phone while driving.
Although it can also be said that road safety is a multifactorial public health issue as many factors are involved in road traffic injuries such as human factors (over speeding, overtaking, not wearing helmet, driving under the influence of alcohol, sudden road crossing without observation, poor visibility, and loss of balance) or vehicle factors (brake failure, problem with head and back lights, overloaded vehicles, and slip of wheel) or environmental factors (absence of reliable and efficient public transport, poor street lighting conditions, unusual behavior of animals, heavy rainfall, obstacle on existing roads, poorly designed roads, absence of traffic signals, or poorly maintained traffic system). Similar observation was observed by Singh and while another study by Kroyer found 79% of the fatal accidents occurred at locations with a mean speed below 50 km/h and 63.2% at locations with a mean speed between 40 and 50 km/h.
In cases where collision occurred with another vehicle, sideways collision was the most common type (63.3% of collisions). This is similar to the findings of a study carried out by Ganveer et al. in Central India where sideways collision was found to be most common mechanism of accident found in 63.59% cases. In the present study, majority of the sideways collision was due to overtake other vehicles and blind turnings.
Both the upper limbs and lower limbs and head and face were the most commonly areas to endure external injuries. The present study found with maximum cases (45.6%) of involvement of multiple site injuries (i.e., head and either of limb) followed by 19% of lower limb injury strictly and 16.3% of head and face injury. The study conducted by Jha et al. depicted 34.1% victims affected by head injuries followed by 13.7% of lower limb injuries.
The present study resulted with maximum 19.7% of disability due to road accidents followed by 4.8% cases of organ dysfunction was notified. Similar findings were recorded in another study by Hatamabadi et al. where they found among 1471 of total study population 91.2% were involved with disability (mild, moderate, and severe disabilities combined) and 7.8% involved with organ dysfunction.
| Conclusion|| |
RTAs were more common in the young adults between 26 and 45 years as observed in this study. The main reasons observed were nonuse of helmets, disobeying traffic rules alcohol consumption, and stress. In 10% of RTAs, distraction due to mobile use was found.
The awareness of risk factors of RTAs and first-aid training to public is needed so that RTAs can be lowered and precious life can be saved. Programme on road safety education can be conducted among school and college students to increase their awareness.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]