Pattern of cranio-intracranial injuries in fatal vehicular accidents in Delhi, 1966--76.

Abstract

The present study was undertaken in the Department of Forensic Medicine of the AH India Institute of Medical Sciences, New Delhi, with the object of studying various aspects of cranio-intracranial injuries in roadside vehicular accident cases. Out of a total of 3227 medicolegal post-mortem examinations conducted, the number of accidental deaths was 2279 (70·62 per cent). Vehicular accidents (1132) comprised 49·76 per cent of the total fatal accidents and 35·5 per cent of the total post-mortems. The incidence of males involved in accidents was 71·74 per cent which was about five times more than females (15·01 per cent). Children below 12 years comprised 13·25 per cent of vehicular accident victims. The most common victim involved was the pedestrian comprising 50·7 per cent, followed by the motorcyclist (18·28 percent). The commonest age group involved in fatal vehicular accidents was between 21–40 years (521 cases, 46·01 per cent). Persons between the age group 11–20 years accounted for 13·69 per cent. Trucks were responsible for accidents in 28·09 per cent of cases, buses in 17·14 per cent and cars in 22·99 per cent; these have been found to be the most common types of vehicles causing fatal accidents. Most of the victims died on the spot (36·30 per cent). A total of 72·5 per cent of the victims died within 24 hours. All victims survived up to a maximum of only 2 weeks, except one case who survived 29 days and died of pyogenic meningitis. Head injuries were responsible for causing death in 71·99 per cent of cases. Chest injuries caused death in 6·18 per cent of cases and abdominal injuries proved fatal in 7·06 per cent of cases. Death by injury to other regions occurred in 15·54 per cent of cases. The incidence of cranio-intracranial injuries was highest in cyclists (78·93 per cent), followed by motorcyclists (72–46 per cent) and pedestrians (66·02 per cent). The number of car occupants involved in fatal accidents was 65·3 per cent. Fracture of the skull was observed in 79·87 per cent of cases; the most common bone involved was the temporal bone (58·67 per cent), followed by the occipital bone (57·75 per cent). Fractures of parietal and frontal bone were almost equal, being 50·38 per cent and 49·37 per cent respectively. The commonest variety of intracranial haemorrhage was subarachnoid haemorrhage (66·9 per cent), followed by subdural haemorrhage (58·2 per cent) and extradural haemorrhage (14·2 per cent). Extradural haemorrhage was least common (14·2 per cent). Intracerebral haemorrhage was found in 22·5 per cent of cases and brain stem haemorrhage in 10·81 per cent. The incidences of contusion and laceration of the brain were almost equal, being 23·6 per cent and 24·8 per cent respectively. Fracture of the ribs was the commonest chest injury, with contusion and laceration of the lung in 18·6 per cent of cases. Laceration of the liver was commonly found in abdominal injury in 17·2 per cent of cases. These findings have been compared with other authors. An attempt was also made in the present study to correlate the post-mortem findings and the survival time in relation to those victims who gave a history of consciousness after the accident and those where there was no history of consciousness. For convenience sake, the post-mortem lesions were divided in grades as 0, I, II, IIa, III and IIIa. The maximum number of fatal cases (46·2 per cent) belonged to grade III (fractured skull, intracranial haemorrhage and brain lesion) followed by grade II (35·1 per cent) (fracture skull and intracranial haemorrhage). No relationship was established between the post-mortem findings, the survival time and the state of consciousness or un-consciousness. The grade II and grade III lesions were common in both conscious and unconscious patients. The commonest complication observed in head injury cases was bronchopneumonia.