AN AUTOPSY STUDY OF THORACO-ABDOMINAL INJURIES IN ROAD TRAFFIC ACCIDENTS

Methods: The present study was conducted in the department of forensic medicine and toxicology of a tertiary care center. The study was carried out during the period of 2 years from 1 st October 2012 to 30 th September 2014. Results: Males between the age group of 21 and 30 years, i.e., 26 victims (26.53%), more vulnerable. Females were more vulnerable in the age group of 51–60 years, i.e., 5 victims (31.25%). Out of total 114 cases, total 48 victims were died on the spot or brought death to the hospital. Lungs were injured in maximum number of victims, i.e., 87 cases (76.31%), followed by the heart, i.e., in 24 cases (20.17%). Liver was the most commonly injured abdominal organ, in 67 cases (58.77%). Conclusion: Maximum cases were spot death. It confirms the urgency to establish the good pre-hospital care and provision of efficient and prompt trauma services at site.


INTRODUCTION
Birth and death are the two extremes of the life, and death is the ultimate truth. However, unnatural death is known for its immense striking shock. Deaths due to road traffic accidents are one of the common forms of unnatural death and its history is as old as the invention of the wheel [1]. More than 1.3 lacks people died on Indian roads, giving India the dubious honor of topping the list of road deaths across the world. With just 1% of the world's vehicles, India manages to account for 10% of its road fatalities [2].
Since the thoraco-abdominal cavity contains the vital organs such as heart, lungs, liver, spleen, stomach, kidney, major blood vessels, and ribs, trauma to this region challenges the integrity and even the viability of the individual. It is a leading cause of death in approximately 25% of trauma patients and, when associated with other injuries, it causes death in additional 50% of multiple trauma patients, usually as a result of hypoxia and hypovolemia. When cardiac trauma is not involved, mortality from isolated penetrating chest injury is low (<1%), but if cardiac trauma is present, mortality rises to about 20% [3].
The present study is carried out to study the pattern of injuries in thoraco-abdominal injuries, along with the survival period.
Aims and objectives 1. To study the pattern of fatal thoraco-abdominal injuries in road traffic accidents.

METHODS
The present study was conducted in the department of forensic medicine and toxicology of a tertiary care centere. The study was carried out during the period of 2 years from 1 st October 2012 to 30 th September 2014. Table 1 shows the males between the age group of 21-30 years, i.e., 26 victims (26.53%), more vulnerable. Females were more vulnerable in the age group of 51-60 years, i.e., 5 victims (31.25%). Table 2 shows the out of total 114 cases, total 48 victims were died on the spot or brought death to the hospital. Out of total 48 cases of spot death, maximum victims were died due to the injury to the thorax and abdomen region, followed by the injury to the thorax region only, i.e., 16 cases.

RESULTS
After applying the Pearson correlation, it was found that, p<0.05, which shows the relation between above parameters was significant. Objectives: More than 1.3 lacks people died on Indian roads, giving India the dubious honor of topping the list of road deaths across the world. With just 1% of the world's vehicles, India manages to account for 10% of its road fatalities. Since the thoraco-abdominal cavity contains the vital organs such as heart, lungs, liver, spleen, stomach, kidney, major blood vessels, and ribs, trauma to this region challenges the integrity and even the viability of the individual.

Research Article
Gushinge et al. Table 4 shows that both the lungs were having a maximum injury of contusion, 64.29% cases in right lung and 35.71% in left lung. In all 24 cases of heart injury, laceration was more common injury, i.e., in 14 cases (58.33%), and contusion was involved in ten cases (41.67%). Table 5 shows that the liver was the most commonly injured abdominal organ, in 67 cases (58.77%). Table 6 shows that out of total 67 cases, liver injury and laceration were present in 77.61% of cases and contusion in 22.39% of cases.

DISCUSSION
RTA causes mechanical trauma, resulting in morbidity, disability, and even mortality. The fatality rate in road traffic accident in India is the highest in the world and reported to be 20 times more than that reported in the developed countries [4]. Table 1 shows the male preponderance to the RTA victim was more than female, which is in accordance with the Khajuria et al. [5], Hanumantha et al. [4], and Lamb et al. [6], with the most vulnerable age group is between 21 and 30 years, which is in accordance with Kachare et al. [7], Murkey et al. [8], and Kumar et al. [9] The reason for these types of observations might be that age group 21-30 years and 31-40 years are more active and exposed to exterior world more frequently for education and job that's why they are more prone to hazards of modern automobile world.
In the present study, a maximum number of victims were died on the spot, which in accordance with the Meera and Nabachandra [10], Murkey et al. [8]. In the present study, more commonly injured organs in thoracic region were lungs 76.31%, which is in consistent with the studies of Khichi et al. [11] (52.7%), Lamb et al. [6] (62%), and Murky et al. [8] (76%). This could be due to the larger size, mobility of lungs in the chest cavity which could be under acceleration and deceleration impact. In the present study, the rib fracture was the most common skeletal injury in the thoracic region, i.e., 77 cases (68.42%) are in consistent with the Singh and Dhattarwal [12] (44%) and Hanumantha et al. [4] 63.3%. This could be due to ribs are most exposed bone to trauma as they are spread over large area.
Although liver is second most frequently injured organ in traffic accident cases with abdominal trauma, it is the most common cause of death following abdominal injury. In the present study, liver was the most commonly involved organ in the abdominal region (58.77%), followed by the spleen (36.84%) (Tables 5 and 6). It is homologus with the previous studies by Lamb et al. [6] (70%) and Khichi et al. [11] (56.3%). Maximum type of injury to liver was of laceration 52 cases out of 67 total cases, i.e., 77.61% (Table 5). Hanumantha et al. [4] observed the same type of results in their study. Liver is most commonly involved organ due to its large size, fixed location, and solid consistency which make it an easy target for blunt injury.

CONCLUSION
The study showed that most RTA deaths, brought to a tertiary care rural hospital, took place either on the spot or within 24 h of injury which is indeed very alarming. It confirms the urgency to establish the good pre-hospital care and provision of efficient and prompt trauma services at site.   Liver  15  52  67  spleen  10  32  42  Right kidney  21  11  32  left kidney  19  6  25  Intestine  5  10  15  Mesentery  9  3  12  stomach  0  11  11  pancreas  1  5  6  diaphragm  2  4 6