Distribution of Causes of Death and Associated Organ Injuries in Road Traffic Accident-Related Fatalities: A Post-mortem Study at Saint Paul’s Hospital Millennium Medical College

doi:10.21203/rs.3.rs-4863195/v1

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Distribution of Causes of Death and Associated Organ Injuries in Road Traffic Accident-Related Fatalities: A Post-mortem Study at Saint Paul’s Hospital Millennium Medical College

https://doi.org/10.21203/rs.3.rs-4863195/v1

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Background: According to the WHO, there were 1.35 million road traffic accident (RTA)-related deaths in 2016, with a significantly higher death rate in developing countries compared to developed ones.

Objective: To assess the distribution of causes of death and associated organ injuries in RTA-related fatalities.

Methods: This retrospective cross-sectional study was conducted at the Forensic Medicine and Toxicology Department of Saint Paul’s Hospital Millennium Medical College (SPHMMC) from January 1 to March 31, 2018. The study included 207 autopsies of RTA-related deaths. Data were analyzed using SPSS version 23.

Results: Among 198 victims, the leading causes of death were craniocerebral injury (19.2%), blunt head injury (17.7%), and multiple injuries (14.6%). The majority (49%) died pre-hospital, 37.9% at the hospital, and 5.6% at home. Pedestrians were the most affected (71%), followed by passengers (16%). Urban areas had a higher incidence of accidents (58.1%). All victims had soft tissue injuries, with 75.3% sustaining head injuries, 58.6% musculoskeletal injuries, and 51% thoracic injuries.

Conclusion: Addressing RTA-related deaths requires a multifaceted approach involving various stakeholders.

1.1. Background:

Mortality from trauma is typically trimodal: the first peak occurs in the pre-hospital phase, due to head injuries and major blood vessel injuries; the second peak happens shortly after hospital admission due to trauma-related complications; and the third peak occurs in the days following trauma, often due to systemic inflammatory response and multi-organ failure^[16]. Road traffic accidents (RTAs) are a leading cause of death worldwide, with significantly higher rates in developing countries compared to developed ones ^[4,17].

1.2. Statement of the Problem:

RTAs are a significant public health issue, surpassing the combined fatalities from HIV/AIDS, tuberculosis, and malaria in some regions. In Ethiopia, RTAs are the leading cause of accidental death, with particularly high rates among vulnerable road users. Despite the severe socio-economic impact, there is a lack of effective legal and preventive measures ^[1,7,10,17].

1.3. Significance of the Study:

This study aims to identify the immediate causes of death and the most commonly injured organs in RTA-related fatalities. Understanding these factors can guide clinical interventions and policy changes to improve road safety and trauma care in Ethiopia.

2.1. General Objective:

To analyze the distribution of causes of death and associated organ injuries in RTA-related fatalities at SPHMMC from January 1 to March 31, 2018.

2.2. Specific Objectives:

· To determine the socio-demographic and other characteristics of RTA-related deaths.

· To identify the immediate causes of death in RTA cases.

· To assess the associated organ injuries in the autopsied bodies.

3.1. Study Area:

The study was conducted at the Forensic Medicine Department of SPHMMC, Addis Ababa, Ethiopia, a national centre for forensic medicine and toxicology.

3.2. Study Period:

December 21, 2019, to August 19, 2020.

3.3. Study Design:

Descriptive retrospective cross-sectional study.

3.4. Study Population:

All autopsies conducted for RTA-related deaths from January 1 to March 31, 2018, at SPHMMC.

3.5. Sample Size & Sampling Procedure:

A sample size of 207 was determined using a single population proportion formula. Sampling was done randomly without replacement.

Inclusion Criteria:

Bodies subjected to complete autopsy.

Exclusion Criteria:

Bodies with external examinations only or non-RTA cases.

3.6. Variables:

· Independent Variables: Sex, age, place of accident, setting of death, type of victim.

· Dependent Variables: Distribution of causes of death and associated organ injuries.

3.7. Plan for Data Collection:

Data were collected using a structured checklist, with modifications during data collection. Collection began after obtaining permission from the forensic medicine department.

3.8. Data Quality Control:

Data completeness and consistency were checked, and analysis was performed using SPSS version 23.

3.9. Operational Definitions:

A transport accidentis any accident involving a device designed primarily for, or being used at the time primarily for, conveying persons or goods from one place to another ^[11].

Underlying causes of death are cascade of events or circumstances that initiate or lead to the immediate causes of death ^[2,11].

Immediate causes of death are injuries or complications that directly preceded death. In other words, the consequences of underlying causes of death ^[2,11].

3.10. Ethical Considerations:

Ethical approval was obtained from the institutional review board, and confidentiality was maintained.

Demographics and General Findings:

Of the 198 victims, 70.7% were male and 29.3% female, with ages ranging from 3 months to 80 years (mean age 34.65, SD=18.07). The most common age group affected was 21-30 years (28.8%) followed by 31-40 years which involved in 20.7% of the cases; in combination they accounted for 49.5 percent of RTA related deaths.

Immediate Causes of Death:

The leading causes were craniocerebral injury (19.2%), blunt head injury (17.7%), and multiple injuries (14.6%).

Immediate causes of death	Frequency	Percent
Cranio-cerebral injury	38	19.2
blunt head injury	35	17.7
multiple injuries	29	14.6
hemorrhage	22	11.1
blunt injury to head and chest	16	8.1
traumatic shock	15	7.6
Sepsis	9	4.5
chest trauma	6	3.0
respiratory failure secondary to veretabro-spinal injury	6	3.0
blunt abdominal and chest trauma	4	2.0
blunt injury to head and abdomen	3	1.5
abdominal trauma	3	1.5
respiratory failure secondary to pneumonia and aspiration	4	2.0
Other causes of death	8	4.0
Total	198	100.0

Table 1: immediate causes of death (n=198)

Setting of Death:

49% of deaths occurred pre-hospital, 37.9% in hospital, and 5.6% at home.

Type of Victim:

Predominantly pedestrians 140 (71%). The remaining are 32 (16%) were passengers, 8 (4%) were drivers,5 (3%) were motorists, 4 (2%) bystanders, 1 (1%) conductor and 8 (4%) of them were unknown victims.

Place of Injury:

Most accidents occurred in urban areas 64 (58.1%) followed by rural area in 64 (32.3%) of the accidents. In the remaining 19 (9.6%) of the victims the place of accident was not recorded.

Associated Organ Injuries:

75.3% had head injuries, 58.6% had musculoskeletal injuries, 51% had thoracic injuries, and 34.8% had abdominal injuries.

Region	Frequency	Percent
Soft tissue injury	198	100
Head trauma	149	75.3
MSS trauma	116	58.6
Chest trauma	101	51
Abdominal injury	69	34.8
Pelvic trauma	10	5.1

Table 2: associated organ injury in RTA related death (n=198)

Out of 198 victims 70.7% of them were male and 29.3% of them were female. The age of the victims ranges from 3 months to 80 years. The mean age was 34.65 years (SD=18.07). The top immediate causes of death were craniocerebral injury, blunt head injury, multiple injuries, hemorrhage, blunt injury to the head and chest and traumatic shock in 19.2%, 17.7%, 14.6%, 11.1%, 8.1% and 7.6% respectively. Forty nine percent of the victims died at pre-hospital level followed by death at hospital in 37.9% of the cases. 5.6% of the victims died at home and in 7.6% of the cases the setting is unknown. Seventy-one percent of the victims were pedestrians, 16% were passengers, 4% were drivers, 3% were motorists, 2% bystanders, 1% co-driver and 4% of them were unknown victims. 58.1% of the accidents occurred in the urban area and 32.3% of the accidents occurred in the rural area. In the remaining 9.6% of the victims, the place of accident was not recorded.

Males are more involved in RTA related death than females which is compatible with other studies. This is probably contributed by the social structure of the community that males are more active outdoors. The age group between 21-40 is the commonest age group affected by RTA as it is seen in many studies ^{[3-8,10,12,13,14,15,16]}. In the contrary Fremingston Marak et al. found the age group between 51-60 is commonly affected ^[9]. This can be contributed by the high proportion of the younger population in the community and higher outdoor activities in this sub-population.

The majority of victims died of craniocerebral injury and blunt head injury as seen in many of the studies ^{[3,5,6,8,9,12]}. In our study, multiple injuries and hemorrhage take the second and third place as the cause of death respectively. In contrary in Kalougivaki JJVP and Goundar RPS study, the second and third commonest cause death are thoracic and abdominal injuries respectively^[12]. On the other hand, Chourasia S et al. found hemorrhage being the second most common cause of death^[3]. Egejuru RO et al. found hemorrhage as the first cause of death^[8].

The majority of the death occurs at the pre-hospital level; this result is compatible with a study done in Fiji^[12]. But in Chourasia S et al. study the majority of death occurred within 12-24 hours of trauma^[3]. Major causes of death in the pre-hospital setting are blunt head injury, multiple injuries, traumatic shock, craniocerebral injury, hemorrhage, and blunt injury to head and chest which is compatible with the trimodal distribution of death^[16].

In our study, high-risk road users are the most affected i.e., pedestrians which is in agreement with many of the studies^. In Kalougivaki JJVP and Goundar RPS study passengers took the first place followed by pedestrians^[12]. The disproportionate pedestrian involvement may be explained by the hurried crossing of roads and distraction of their concentration by other thoughts while crossing roads.

In our study Majority of the accidents occurred in urban areas which is in agreement with the findings of Abegaz T and Gebremedhin^[1]. On the other hand, Dr. Awdhesh Kumar and Dr. S. K. Pander found a high rate of accidents in the rural area^[6]. This high rate of accidents in urban areas can be explained by disproportionate high numbers of vehicles in cities and towns of Ethiopia, high activities and Population movements in these areas, and disproportionate traffic congestion. The other reason could be rural area victims may not be admitted for autopsy due to cultural barriers and needs further investigation.

Apart from soft tissue injury head is the commonest region involved in RTA, followed by musclo-skeletal injury, thoracic injury and abdominal injury as it is seen in other studies^{[3, 8]}. Head trauma took the first place of trauma in RTA in other two studies with different order of involvement of other body regions^[8,12].

Top immediate causes of death in head trauma were cranio-cerebral injury, blunt head injury, multiple injuries, blunt head and chest trauma and from traumatic shock in descending order of frequency which is in agreement with other study^[8].

The study found a higher prevalence of RTA-related fatalities among males and young adults, consistent with previous research. Craniocerebral injuries were the most common cause of death, reflecting trends seen globally. The majority of deaths occurred pre-hospital, highlighting the need for improved emergency response systems. The high incidence of pedestrian fatalities suggests a need for better road safety measures targeting vulnerable road users. This study's findings are in line with other studies but differ in some specifics, indicating the need for localized interventions and further research.

The study underscores the critical need for comprehensive road safety measures and improved trauma care to address the high rates of RTA-related deaths. Targeted interventions should focus on enhancing emergency medical services, enforcing traffic laws, and protecting vulnerable road users. Collaborative efforts among stakeholders are essential to reduce RTA fatalities and improve road safety in Ethiopia.

· AIDS: Acquired Immune Deficiency Syndrome

· CI: Confidence Interval

· eFAST: Extended Focused Abdominal Ultrasound in Trauma

· GC: Gregorian Calendar

· HIV: Human Immunodeficiency Virus

· ICH: Intracerebral Hemorrhage

· MOH: Ministry of Health (Ethiopia)

· MSS: Musculoskeletal System

· PTB: Pulmonary Thromboembolism

· RTA: Road Traffic Accident

· RUSH: Rapid Ultrasound in Shock and Hypotension

· SAH: Subarachnoid Haemorrhage

· SPHMMC: Saint Paul’s Hospital Millennium Medical College

· SD: Standard Deviation

· SPSS: Statistical Package for Social Sciences

· UK: Unknown

· WHO: World Health Organization

Funding

It is from our pocket.

Authors’ contribution

Both (S.G. & T.S.) authors contributed equally.

Affiliations of the authors

Dr. Sete is lecturer at woldia university,woldia Ethiopia and dermatovenerology resident in Bahirdar university, Bahirdar Ethiopia.

Dr. Temesgen is one health lessons administrative intern, Addis Ababa Ethiopia

Registration details

Not applicable to this study design.

Data availability

Yes, the research data are available.

Human ethics and consent

Consent is not applicable, but every measure was taken to ensure the confidentiality of victims’ data.

Acknowledgment

We would like to thank Dr. Sessen (department head of forensic medicine and toxicology) and her staff for their welcoming and unreserved support.

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No competing interests reported.

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You are reading this latest preprint version

Distribution of Causes of Death and Associated Organ Injuries in Road Traffic Accident-Related Fatalities: A Post-mortem Study at Saint Paul’s Hospital Millennium Medical College

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Version 1

Abstract

1. INTRODUCTION

2. OBJECTIVES

3. METHODS AND MATERIALS

4. RESULTS

Discussion

Conclusion

ABBREVIATIONS

Declarations

References

Additional Declarations

Status:

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