CHARACTERISTICS OF TRAUMA CIRCUMSTANCES AND RECEIVED INJURIES IN VICTIMS OF ROAD TRAFFIC ACCIDENTS IN ARCTIC ZONE OF ARKHANGELSK REGION Baranov A.V., Klyuchevskiy V.V., Petchin I.V., Barachevskiy Yu.E., Menshikova L.I.
Arkhangelsk Regional Clinical Hospital,
Northern State Medical University, Arkhangelsk, Russia,
Yaroslavl State Medical University, Yaroslavl, Russia
CHARACTERISTICS OF TRAUMA CIRCUMSTANCES AND RECEIVED INJURIES IN VICTIMS OF ROAD TRAFFIC ACCIDENTS IN ARCTIC ZONE OF ARKHANGELSK REGION
Safety and health of thepopulation is the basis of socioeconomic development of the state. The main role is given to decreasing rates of injuries and mortality after external causes including road traffic accidents (RTA) [1-3].
Severodvinsk is one of the most important centers in the arctic zone of Arkhangelsk region. Here, the federal road (FR) M-8 “Kholmogory” ends. It connects the center of atomic ship manufacturing with the regional center, and has some features of the Northern roads promoting the appearance of RTA with prevailing proportion of polytraumas [4]. Traditionally, RTA-associated injuries present one of the most severe types of trauma, with 8-10 % of polytraumatized patients among all trauma patients treated in big hospitals, and with mortality of 60 % [5-8]. Notion of causes and circumstances of RTA injuries is significant for realization of timely and qualitative diagnostics and further treatment [8. 9]. This data testifies the doubtless actuality and necessity of studies of rates of RTA injuries in Russian Arctic Region.
Object – to give a description of the circumstances of injuries and trauma in victims of road traffic accidents in the Arctic zone of Arkhangelsk region.
MATERIALS AND METHODS
The materials of the study were presented by the sample of 518 medical records (form 003/u) of the patients who suffered in RTA and were urgently admitted to the multi-profile hospitals of Severodvinsk during the period from January 1, 2012 till December 31, 2016. The medical records were selected according to the criteria of retrospective complete documental observation (all medical records of RTA victims who received inhospital treatment for five year period).
The inclusion criteria were:
1. Male or female.
2. Age ≥ 18.
3. RTA victim in Severodvinsk of Arkhangelsk region or on the FR M-8 “Kholmogory” in the area of responsibility of Severodvinsk emergency medical aid service, who received inhospital treatment.
4. Getting injured in 2012-2016.
The signs and characteristics selected for the analysis:
1. Male and female.
2. Age.
3. Circumstances of RTA (driver, passenger, motorcycle, pedestrian).
4. Site of incident (city, road).
5. Injury type (single, multiple or concomitant).
6. Postmortem diagnosis.
7. Discrepancies in clinical and postmortem diagnoses.
The mean values were calculated for quantitative signs: median (the first and third quartiles) and simple mean arithmetic (mean square deviation). Normalcy of distribution of quantitative signs was estimated with Kholmogorov-Smirnov test. Non-parametric Mann-Whitney test was conducted for comparison of two mean values in conditions of data nonconformance in relation to the parameters of normal distribution. The analysis of categorical signs was conducted with the method of contingency tables and calculation of Pearson’s chi-square test and Fisher’s two-tailed exact test (for 4-field tables). The analysis was conducted with SPSS applied software 22. The probability of accidental error less than 5 % was selected as a criterion of statistical significance (p < 0.05).
The study was conducted in compliance with the ethical standards of Helsinki declare. The study protocol was approved by the expert board of biomedical ethics of Northern State Medical University (the protocol No. 08/11-17, November 29, 2017).
RESULTS AND DISCUSSION
During the review of the RTA circumstances in the studied region, we separated the following categories of patients: pedestrians suffered in RTA – 169 (32.6 %), car drivers – 143 (27.6 %), car passengers – 144 (27.8 %), motorcyclists – 62 persons (12 %) (the table 1).
Table 1. Gender characteristics of victims of road traffic accidents in dependence on circumstances of injury
|
Structure of patients |
Pedestrian |
Passenger |
Drivers |
Motorcycle acciden |
Total |
p level |
|
Men |
76 |
64 |
117 |
52 |
309 |
1-4 = 0.0167 |
|
Women |
93 |
80 |
26 |
10 |
209 |
1-4 = 0.000 |
|
Total |
169 |
144 |
143 |
62 |
518 |
1-4 = 0.000 |
All reviewed categories of RTA victims receive quite specific injuries. So, after auto-pedestrian accidents, pedestrians often have damages of pelvic bones, of lower extremities and traumatic brain injuries of various severity as a consequence of frontal or lateral high energy impact. In car drivers, the prevailing injuries include the chest and the abdomen as result of hitting the driving wheel.
It was found that male drivers more often receive RTA injuries as compared to female drivers (p = 0.001), but women are more often injured in RTA as pedestrians and passengers (p = 0.05).
255 (49.2 %) victims of RTA had some single injuries (p < 0.001). Multiple injuries were noted in 72 (13.9 %) victims, concomitant injuries – in 191 (36.9 %).
There were more men than women in all groups of victims. The highest amount of women was noted in the group of single injuries (Fig. 1).
Figure 1. Distribution of victims of road traffic accidents in dependence on injury type and gender (%)
It can be explained by the fact that women are more careful drivers and pedestrians, and they consume alcoholic drinks rarer. Therefore, they receive less severe injuries.
After estimation of percentage ratio of injured persons in relation to circumstances of injuries, we noted that the percentage of single injuries was approximately the same in all studied categories, but pedestrians and drivers receive significantly more severe concomitant injuries, with ratio of 40 % (Fig. 2).
Figure 2. Distribution of victims of road traffic accidents in dependence on type of injuries and circumstances
As for the age of RTA victims, we noted the concomitant injuries in the persons at the age of 41 (29-56), multiple and single injuries – at the age of 35 (26.0-51.5 and 26.0-51.0 correspondingly). It was found that the victims with concomitant injuries were older than the patients with other types of the injuries (p < 0.01). Motorcycle injuries are common for young people.
The highest age of the injured men was noted in pedestrians, in the women – in car drivers (the table 2).
Table 2. Age characteristics of victims of road traffic accidents in dependence on circumstances of injury
|
Structure of patients |
Pedestrians |
Passengers |
Drivers |
Motorcycle accident |
Óðîâåíü p |
|
Men |
44 |
33 |
37 |
32,5 |
1-2 = 0.000 |
|
Women |
54 |
36.5 |
32 |
32.5 |
1-2 = 0.000 |
|
Total |
47 |
54 |
36 |
32,5 |
1-2 = 0.000 |
The review of the age in the examined groups showed that the female pedestrians who suffered in RTA were older than the men, but the male passengers were significantly younger.
The number of RTA victims for the studied period (5 years) was 371 (71.6 %) and 147 (28.4 %) persons on the roads which are adjacent to the city. Drivers and passengers presented the main group of the victims on the FR M-8 “Kholmogory”. In Severodvinsk, pedestrians presented the dominating group (the table 3).
Table 3. Characteristics of victims of road traffic accidents in dependence on accident site
|
Road accident site |
Pedestrians |
Passengers |
Drivers |
Motorcycle accident (4) |
p level |
|
Severodvinsk |
144 |
93 |
86 |
48 |
1-2 = 0.0001 |
|
Automobile roads |
25 |
51 |
57 |
14 |
1-2 = 0.0005 |
|
Total |
169 |
144 |
143 |
62 |
1-2 = 0.0925 |
It can be explained by the absence of high amount of pedestrians on the regional and federal roads, with higher speed of vehicles than on the urban roads, where pedestrians often violate the traffic regulations, resulting in higher amount of injuries.
The estimation of the quantitative features of location of injuries showed the higher amount of victims with severe multiple and concomitant injuries on the federal and regional roads than on the urban roads of Severodvinsk. We believe that that fact is determined by higher speed on the federal and regional roads, resulting in high energy polytrauma (Fig. 3).
Figure 3. Distribution of victims of road traffic accidents in dependence on accident site and injury type (%)
The analysis of the time course of the circumstances of the injuries for 5-year period showed the increase in the proportion of RTA with motorcycles from 12.1 % in 2012 to 15.2 % in 2016 (Fig. 4).
Figure 4. Time course of proportion of victims of road traffic accidents in dependence on injury circumstances (%)
It is determined by the fact that a motorcycle is a popular vehicle among young people, with high injury risk.
The proportion of pedestrians had been increasing for 5-year period. The proportion of car drivers among victims of RTA decreased from 33.6 % in 2012 to 20.3 % in 2016. According to our opinion, it can be determined by decreasing speed mode due to worsening of quality of the roads in the streets of Severodvinsk and increasing penalties for speed limit exceeding.
The analysis of the results of the hospital treatment in the multi-profile hospitals of Severodvinsk showed 10 (1.9 %) cases of hospital mortality in RTA victims: 6 (60 %) men and 4 (40 %) women, the mean age of 34 [25; 56] years.
The distribution of the circumstances of the injuries was as described below: 6 (60 %) pedestrians, 2 (20 %) car passengers, 1 (10 %) car driver and 1 (10 %) motorcycle driver. 4 (40 %) persons suffered on the roads of Severodvinsk , 6 (60 %) – on the FR M-8 “Kholmogory” and the adjacent roads.
Polytrauma was identified in 9 victims, multiple head injury – in 1. The cause of death was cerebral edema and dislocation and multiple organ insufficiency. The postmortem examination did not identify any discrepancies in clinical and pathological diagnoses.
The insignificant proportion of hospital mortality (1.9 %) in Severodvinsk was determined by development of the level 1 trauma center on the basis of Arkhangelsk Regional Clinical Hospital which accepts victims with severe road injuries in the whole region by means of urgent evacuation of critically ill patients by the reanimobile with the highly experienced team or by sanitary aviation from remote or hard-to-get places of Arkhangelsk region.
11 (2.1 %) critically ill patients with polytrauma were admitted to the level 1 trauma center from Severodvinsk hospitals and received the urgent surgical interventions and the procedures for stabilizing their condition.
CONCLUSION
1. Drivers and passengers of motor cars presented the main category of patients among RTA victims on the federal and regional roads near Severodvinsk, but pedestrians were the main group of victims on the urban roads.
2. It was found that pedestrians and car drivers have the higher percentage of polytraumas (up to 40 %). The amount of RTA victims with severe multiple and concomitant injuries on the FR M-9 “Kholmogory” and on the regional roads was higher than on the urban roads of Severodvinsk.
3. In accidents with motorcycles, the main category of victims was young people (up to 39 years); for other types of transport, the main proportion of victims was older patients, among women – car drivers (p < 0.01).
4. The proportion of motorcycle accidents increased to 15.2 %, the rate of injuries in car drivers decreased to 20.3 %.
5. Hospital mortality in RTA victims was 1.9 %, with severe concomitant injuries in most of them (90 %). The insignificant hospital mortality in RTA victims in the hospitals of Severodvinsk was determined by transfer of the most severe patients with polytrauma to the level 1 trauma center in Arkhangelsk Regional Clinical Hospital.