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Study on risk factors of road traffic accident victims attending a tertiary care hospital at Tirupati

Globalization has led to the expansion in the road network along with rise in motorization of vehicles. Simultaneous population explosion and rapidly increasing use of motor vehicles has led to rise in the number of road traffic related accidents, road accident injuries and fatalities. Thereby road traffic accidents stand as one of the leading causes of mortality and morbidity across the globe. Approximately 1.24 million people die every year on the roads across the world, and another 20 to 50 million sustain nonfatal injuries as a result of road traffic accidents. Eighty per cent of road traffic deaths occur in middle socio-economic countries, which account for 72% of the world’s population, but only 52% of the world’s registered vehicles. 1 In South-East Asia Region during 2010, around 3.35 lakh people died from road traffic injuries with the road traffic death rate of 18.5 per 1 lakh population. Further the total number of registered ABSTRACT


INTRODUCTION
Globalization has led to the expansion in the road network along with rise in motorization of vehicles. Simultaneous population explosion and rapidly increasing use of motor vehicles has led to rise in the number of road traffic related accidents, road accident injuries and fatalities. Thereby road traffic accidents stand as one of the leading causes of mortality and morbidity across the globe. Approximately 1.24 million people die every year on the roads across the world, and another 20 to 50 million sustain nonfatal injuries as a result of road traffic accidents. Eighty per cent of road traffic deaths occur in middle socio-economic countries, which account for 72% of the world's population, but only 52% of the world's registered vehicles. 1 In South-East Asia Region during 2010, around 3.35 lakh people died from road traffic injuries with the road traffic death rate of 18.5 per 1 lakh population. Further the total number of registered vehicles increased by 28% from 2009 to 2013. There is no comprehensive legislation on five key risk factors for road traffic injury which include speeding, drink-driving, use of motorcycle helmets, seat-belts and child restraints in any of the South-East Asia Region countries. 2 Road traffic injures in developing counties mostly affect pedestrians, passengers and cyclists as opposed to drivers who are involved in most of the deaths and disabilities occurring in the developed world. The reasons for the high burden of road traffic injuries in developing countries are increase in the number of motor vehicles, poor enforcement of traffic safety regulations, inadequacy of health infrastructure, and poor transport facility. 3 In India, 1.27 lakh people died in road accident during 2009 resulting a financial cost of approximately 1.36, lakh crore Indian rupees. 4 Road traffic accidents can be easily compared with gigantic infamous tsunami. Road crashes deserve to be a strategic issue for any country's public health and can lead to overall growth crisis, if not addressed properly. 5 Sri Venkateswara Ramnarayan Ruya Government General Hospital (SVRRGGH) is a tertiary care hospital of the government of Andhra Pradesh at Tirupati. It plays a major role as a government referral centre in Chittoor district. Victims of road traffic accidents in both rural and urban areas who require tertiary care are referred to SVRRGGH, Tirupati. The objectives of the study include.
1. To know the role of victims in RTA. 2. To study various risk factors related to RTA. 3. To determine the association of risk factors with type of injury. 4. To know the pre-existing disorders in RTA victims.

METHODS
A hospital based, cross sectional study with victims of road traffic accidents admitted in S.V.R.R. Government General Hospital, Tirupati, as study subjects was done. All road traffic accident cases admitted for at least more than 24 hours were included into the study. Exclusion criteria include victims of road traffic accidents admitted for less than 24 hours, Cases treated on outpatient basis and not admitted into hospital, Victims who were immediately referred to higher centre, In case of unconscious patient & if the family members are not willing to participate, Cases not willing to participate in the study. Study was conducted at departments of Emergency, Surgery, Orthopedic and Neurosurgery at S.V.R.R. Government General Hospital, Tirupati for a period of one year from June 2013 to May 2014 after obtaining approval from institutional ethical committee.
A pilot study was conducted for a period of one month during May 2013 by using a pre-designed questionnaire and necessary corrections were made. A total of 820 cases of road traffic accidents reported to the Emergency, Surgery, Orthopedic and Neurosurgery units of S.V.R.R. Government General Hospital at Tirupati were interviewed after taking prior consent using a predesigned questionnaire. In case if patient is not in a situation to respond, information was collected from family members, relatives, or friends. Data was entered into MS excel and analyzed using Epi-infoTM 7.1.3.10 version software and appropriate statistical tests of significance were employed like Chi-Square test for significance of difference in proportions.

RESULTS
The informant in the majority of the cases was found to be the person himself / herself (70.1%) followed by family members (25.5%) and friends (3.6%). By age group, 27.0% of the subjects belong to 20-29 years followed by 30-39 years (26.3%). It was found that the age of the subjects was less than 40 years in 63.8% cases. A large majority of the subjects was males (85.0%) and Hindus by religion (87.2%) and married (68.7%). Majority of the subjects were secondary literates (34%) followed by illiterates (22.3%). Majority of the subjects were semi-skilled by occupation (31.5%) followed by students (15.7%). It was found that majority of the subjects belonged to upper lower socio-economic status (44.1%) followed by lower middle economic status (20.0%). Further, it was found that a large majority of them belonged to rural areas (77.7%). 6     Only 26% of the four wheeler occupants were using seat belt ( Figure 1). It was found that 29.2% were under the influence of alcohol, 12.7% were listening to music, 6.8% each were using mobile phones or engaged in conversation. Further 9.5% had some form of stress at the time of accident, 6.3% had a history of road traffic accidents while 4.1% were smoking /chewing tobacco at the time of accident (  (Table 3).

Figure 1: Percentage of Seat belt usage in four wheelers including drivers & passengers (N=54).
Passenger position was mostly in the back (83.1%) in contrast to front (11.1%) and middle position (5.0%). The passenger density was mostly normal (80.4%) while over speed of the vehicle was reported in as much as 55.8% of the respondents (Table 4).
Among 34 four wheeler passengers, 30 were not using seat belt and 21 had suffered grievous injury. 67.6% of the victims who felt that their vehicle was over speed had sustained grievous type of injury. Regarding position most of the front (74.2%) and middle (61.5%) passengers had grievous injury followed by passengers at back (56.9%). Similarly all the passengers in low occupant vehicles (100%) had grievous injury whereas 59.8% and 55.1% of normal density and of crowded vehicle passengers respectively had grievous injury (Table 5).  Hypertension was found in 17.1% of cases while diabetes was found in 11.0% cases. Frequent blackouts were reported in 4.5% patients while uncorrected visual and auditory disabilities were found in 3.9% and 3.5% respectively ( Figure 2).

DISCUSSION
Out of 820 victims, Most of the victims were drivers (48.5%) followed by passengers (31.7%) and pedestrian (19.8% In the present study, 29.2% of the victims of RTA were found alcoholic. Study at Haryana, shown that among the victims 18.01% gave a history of alcohol consumption within 6 hours before the RTA. 15 In a WHO supported study, 16.9% of drivers were found to consume alcohol 2 to 3 hours prior to accident. 16 Similarly Sreedharan et al had found that 20% of the motorcycle riders had consumed alcohol. 17 6.8% were talking in mobile phones at the time of RTA and 6.3% had previous history of RTA in the present study, whereas 42.4% of young drivers had used mobile phones while driving in Gujarat and 6% had met accident in past in Agarwal et al study. 18,19 Among 260 passengers, 18.8% responded that vehicle was crowded during RTA. While study by Manna et al it was 15.5%. 20 Similar observations was also seen in studies conducted by Ganveer et al and Patil et al. 21,22 Overloading leads to loss of balance and loss of control over the vehicle which eventually leads to accident.

CONCLUSION
There is a need for encouraging and promoting safe driving behaviour among community members by increasing the awareness through road safety campaigns. More over by establishing integrated surveillance systems, information regarding road traffic injury burden and their causal/risk factors can be generated, which hopefully help in developing preventive measures. Enforcement of stringent laws by implementing penalty and imprisonment if required for those violating traffic rules.