Road traffic accidents at Government General Hospital, Kakinada, in 2018-19 versus 2019.20: Case series

Korukonda Babji; Manukonda Raghavendra Rao; Goru Krishna Babu; J S. Surya Prabha Kona; Vandana Valluri

doi:10.4103/JDRNTRUHS.JDRNTRUHS_103_20

ORIGINAL ARTICLE

Year : 2021 | Volume : 10 | Issue : 1 | Page : 1-7

Road traffic accidents at Government General Hospital, Kakinada, in 2018-19 versus 2019.20: Case series

Korukonda Babji¹, Manukonda Raghavendra Rao², Goru Krishna Babu³, J S. Surya Prabha Kona³, Vandana Valluri³
¹ Department of General Surgery, Rangaraya Medical College, Kakinada, Andhra Pradesh, India
² Department of Pulmonary Medicine, Government General Hospital, Kakinada, Andhra Pradesh, India
³ Department of Community Medicine, Rangaraya Medical College, Kakinada, Andhra Pradesh, India

Date of Submission	28-Jul-2020
Date of Decision	18-Feb-2021
Date of Acceptance	02-Mar-2021
Date of Web Publication	19-May-2021

Correspondence Address:
Dr. Goru Krishna Babu
Professor & Head of the Department, Department of Community Medicine, Government General Hospital, Kakinada, Andhra Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/JDRNTRUHS.JDRNTRUHS_103_20

Abstract

Background: Alcohol-related road traffic accidents (RTAs) are the foremost threat to the civilization due to premature loss of life. Policy-making is one such tool for reduction of alcohol-related RTAs. Andhra Pradesh state government implemented the Prohibition and Excise Policy for 2019-20 with respect to liquor sales from October 1, 2019 to September 30, 2020_.
Aim: This study aims at documenting the reduction of alcohol-related RTAs (head injuries and others) after the introduction of the new policy.
Methodology: Case series involving all the RTAs reported to the Government General Hospital, Kakinada, during September 2018–February 2019 and September 2019–February 2020. Secondary data was collected using a semi-structured questionnaire, from the hospital accident registers, in the medical records department. Data was analyzed using Microsoft Excel 2010.
Results and Discussion: There is a significant decrease in number of fractures sustained in RTAs from 12.5% in 2018–19 to 9.5% in 2019–20 (P = 0.018, 95% CL). The proportion of RTAs occurring under the influence of alcohol reduced from 9.4% in 2018–19 to 8.4% in 2019–20. There is a marked reduction in deaths of RTA cases, and grievous injuries and head injuries have also reduced during September 19–February 2020 as compared to September 18– February 2019.
Conclusions: The fatal injuries sustained in RTAs under the influence of alcohol dramatically reduced to zero from November 2019 to February 2020, suggesting a protective effect of the new prohibition of liquor sales policy.

Keywords: Alcohol, head injuries, road traffic accidents

How to cite this article:
Babji K, Rao MR, Babu GK, Kona J S, Valluri V. Road traffic accidents at Government General Hospital, Kakinada, in 2018-19 versus 2019.20: Case series. J NTR Univ Health Sci 2021;10:1-7

How to cite this URL:
Babji K, Rao MR, Babu GK, Kona J S, Valluri V. Road traffic accidents at Government General Hospital, Kakinada, in 2018-19 versus 2019.20: Case series. J NTR Univ Health Sci [serial online] 2021 [cited 2023 Mar 27];10:1-7. Available from: https://www.jdrntruhs.org/text.asp?2021/10/1/1/316307

Introduction

Road traffic accidents (RTAs) are among the top ten leading causes of death across the world. Deaths due to RTAs have increased from 1.25 million per year in 2015^[1] to 1.35 million per year^[2] in 2018, i.e., 3,700 people dying due to RTAs every day or nearly 2–3 RTA deaths occurring every minute in the world. Globally, accidents are the most common cause of death in the 5–29 years age group.^[2] Indian researchers, working on road safety, in a recent study, concluded that alcohol-related RTAs are a foremost threat to the civilization.^[3] Policy-making is one such tool for the reduction of alcohol-related RTAs. Prohibition and Excise Policy for 2019-20 with respect to liquor sales is being implemented by the Andhra Pradesh state government from October 1, 2019 to September 30, 2020.^[4]

Aim

The aim of the study is to document the reduction of alcohol-related RTAs (head injuries and others) after the introduction of the new policy.

Objectives

To assess the magnitude of RTAs brought to GGH, Kakinada, in the months of September 2018 to February 2019.
To assess the magnitude of RTAs brought to GGH, Kakinada, in the months of September 2019 to February 2020.
To classify the RTAs based on alcohol consumption, the nature of injuries, and the anatomical distribution of injuries.
To document the difference in the magnitude of RTAs, influence of alcohol on accidents, nature of injuries, and the anatomical classification of injuries for the above periods.

HYPOTHESIS: Implementation of excise policy will lead to a reduction in the magnitude of RTAs with special reference to the nature of injuries under the influence of alcohol.

Methodology

Study Design: Case series.

Study Setting: Government General Hospital, Kakinada.

Study Sample: All people brought to the Government General Hospital, Kakinada, with RTAs during the months of September, October, November, and December, in the years 2018 and 2019 and during January and February in 2019 and 2020.

Sampling method: All the RTAs entered into the accident registers were chosen for the study.

Data Collection: Secondary data was collected using a semi-structured questionnaire, from the hospital accident registers, in the medical records department.

Data Analysis: Data was analyzed using Microsoft Excel 2010.

Operational Definitions:

Road traffic accidents: An RTA is any injury due to crashes originating from, terminating with or involving a vehicle partially or fully on a public road.^[5]
Road traffic accidents under the influence of alcohol: RTA cases in which a history of intake of alcohol was recorded.
Nature of injuries:

“Simple”: Any injury that does not classify as grievous or fatal.^[6]
“Grievous”: Emasculation/Permanent privation of the sight of either eye, or hearing of either ear or of any member or joint/Destruction or permanent impairing of the powers of any member or joint/Permanent disfiguration of the head or face/Fracture or dislocation of a bone or tooth/Any hurt which causes the sufferer to be in severe bodily pain for 20 days or unable to follow ordinary pursuits.^[6]
“Fatal”: Any injury endangering life.^[6]

Results and Discussion

In the Sustainable Development Goals, world leaders have committed to halve the number of deaths from road crashes by 2020.^[7] WHO is committed to working with countries to reduce the preventable deaths and disability caused by RTAs. The reasons for the rise in RTAs include: rapid urbanization, poor safety standards, lack of enforcement, people driving distracted or fatigued, others under the influence of drugs or alcohol, speeding, and a failure to wear seat-belts or helmets. Strong policies and enforcement, smart road design, and powerful public awareness campaigns can save millions of lives over the coming decades.

India unfortunately ranks at the top with the highest number of fatalities contributing to 11% in the world.^[8] The total number of accident-related deaths in 2018 stood at 1,51,417 indicating an increase of 2.3% than that in 2017.^[8] Andhra Pradesh ranks 7^th in the country for RTAs.^[8] A total of 24,475 RTAs occurred in Andhra Pradesh during the year 2018.^[8] With this background, the Indian central and state governments are now planning and implementing prohibitory laws and policies to cut down the magnitude of RTAs.

A Prohibition and Excise Policy for 2019-20 with respect to liquor sales aims at reducing the availability of alcohol in terms of costs, shops, duration of sales, and distributors.^[4] This study was undertaken to assess the magnitude of reduction in RTAs (head injuries and others) and the nature of injuries under the influence of alcohol, reported to the Government General Hospital, Kakinada. The magnitude of reduction in RTAs can only be assessed by comparing the data documented during the year 2018–19 during the same months (September to February).

A total of 1299 RTAs were reported from September 2019 to February 2020 as compared to 1276 RTAs from September 2018 to February 2019. The average number of accidents occurred at the same time in 2018–19 is 212.67 as compared to 216.5 in 2019-20. The magnitude of RTAs ranged from 14.2% in November 2018 to 20.06% in January 2019 during 2018-19 as compared to 9.7% in December 2019 to 21.4% in January 2020 during the 2019-20 period, as shown in [Figure 1]. This difference was found to be statistically significant, P = 0.000 (95% CL). It is seen from [Figure 1] that the number of accidents seems to have peaked between September 2019 and November 2019, and a sudden drop occurred in December 2019 followed by a peak in January 2020 and another drop in February 2020. For the similar period in 2018–19, there is a gradual increase in the number of accidents, peaking in the months of January and February 2020. This difference is found to be statistically significant, P = 0.000 (95% CL).

Figure 1: Line diagram showing comparison of magnitude of RTAs occurring between Sep'18 – Feb'19 and Sep'19 – Feb'20

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69.4% of the accidents are seen to occur in the age group of 18–45 years in 2018–19 as compared to 70.2% in 2019–20 [Table 1]. However, this difference was not found to be statistically significant, P = 0.41 (95% CL). In the study done by Chowdri et al.^[9] in Mangaluru city, most of the road accidents were caused by people aged 25–45 years. In another study done by Singh et al.,^[10] 40.63% of the victims of RTAs belong to the 20–30 years age group.

Table 1: Age-Wise Distribution of RTAS During Sep'18 - Feb'19 and Sep'19 - Feb'20

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The proportion of men involved in accidents from September 2018 to February 2019 is 80.8% (19% were women) as compared to 84.1% from September 2019 to February 2020 (15.9% were women) [Figure 2]. This difference is found to be significant, P = 0.045 (95% CL). Similar results were found in the study done by Singh et al.,^[10] where 74.35% of RTA victims were males, and in another study done by Karpoor et al.^[11] in Belgavi, where 92% of RTA victims were males.

Figure 2: Gender-wise distribution of RTAs for the years Sep'18-Feb'19 and Sep'19- Feb'20

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There is no statistically significant difference in the distribution of RTAs as per the time of occurrence between September 2018 and February 2019 and September 2019 and February 2020, P = 0.47 (95% CL). However, there is a shift in the occurrence of magnitude RTAs from 6pm to 12am midnight in 2018-19 to 12 noon to 6pm in 2019-20 [Table 2]. Similar results were found in a study done by Madhab et al.^[12] in Vadodara. Jani et al.^[13] and Rao et al.^[14] found in their studies that the highest number of RTAs occurred between 6pm–12am and 12pm–6pm.

Table 2: Distribution of RTAS Based on Time of Occurrence During Sep'18 - Feb'19 and Sep'19 - Feb'20

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[Figure 3] shows that the percentage of RTAs occurring in the months of October to November have come down drastically in the months of December 2019 to February 2020. A marginal reduction for the above period was observed in the previous year. There is a significant fall in magnitude of fatal injuries sustained in RTAs, from 4.5% in September 2018–February 2019 to only 2.2% in September 2019–February 2020, P = 0.001 (95% CL) [Table 3]. The cases with no visible injuries have increased from 5.3% in September 2018–February 2019 to 7.9% in September 2019–February 2020. In our study, grievous injuries were most common in both the periods, i.e., 2018–19 as well as 2019–20, whereas the study by Karpoor et al.^[11] found that RTA-injuries were mostly fatal with severe head injuries. During September 2019–February 2020, the proportion of simple injuries increased in the months of November and January [Figure 4]. The fatal injuries sustained in RTAs under the influence of alcohol dramatically reduced to zero from November 2019 to February 2020, whereas there was a steady rise in such injuries during the same period in 2018-19 [Figure 5]. This suggests a protective effect following the implementation of the new prohibition of liquor sales policy.

Figure 3: Month-wise trend in RTAs occurring between 12am to 6am

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Table 3: Distribution of RTAS Based on Nature of Injuries Sustained, in Sep'18 - Feb'19 and Sep'19 - Feb'20

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Figure 4: Line diagram showing the month-wise distribution of grievous and fatal sustained in RTAs occurring during Sep'18 – Feb'19 and Sep'19 – Feb'20

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Figure 5: Month-wise trends in occurrence of grievous and fatal injuries sustained in RTAs under the influence of alcohol in Sep'18 – Feb'19 and Sep'19 – Feb'20

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The proportion of RTAs occurring under the influence of alcohol reduced from 9.4% (120/1276) in 2018–19 to 8.4% (109/1299) in 2019–20 [Figure 6]. However, this reduction was not statistically significant, P = 0.366 (95% CL). In a study done by Baruah et al.^[12] on the incidence of alcohol use in fatal RTAs, 20% of total RTA deaths were due to alcohol.

Figure 6: Distribution of RTAs under the influence of alcohol during Sep'18 – Feb'19 and Sep'19 – Feb'20

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There is a steady increase in the number of accidents occurring under the influence of alcohol in 2018–19 as compared to a steady decline in the number of accidents occurring under the influence of alcohol in 2019–20 from September to December followed by a peak in January and February [Figure 7]. This difference in the distribution of RTAs under the influence of alcohol is statistically significant, P = 0.000 (95% CL). In the study done by Karpoor et al.^[11] on the effect of alcohol ban (on National Highways in Belgavi) on RTAs, the number of RTAs had reduced in 2017–18 (post ban) as compared to 2016–17 (pre ban).

Figure 7: Line diagram showing the Month-wise trend of RTAs occurring under the influence of alcohol during Sep'18 – Feb'19 and Sep'19 – Feb'20

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49.1% of the RTAs involved the head during September 18–February 19 as compared to 48.3% in September 19–February 20 [Figure 8]. The anatomical distribution of injuries is not different for the years 2018–19 and 2019–20. Cases with no visible injuries have increased during 2019–20 (8%) as compared to 2018–19 (5.3%). In contrary, the study by Singh et al.,^[9] found that the extremities (53.54%) were most commonly injured in RTAs. The occurrence of head injuries in RTAs registered a fall during the months of December 2019 and February 2020 as compared to September 2018–February 2019 [Table 4].

Figure 8: Distribution of RTAs as per site of injury in Sep'18 – Feb'19 and Sep'19 – Feb'20

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Table 4: Month-Wise Distribution of Head Injuries Sustained in RTAS in Sep'18 - Feb'19 and Sep'19 - Feb'20

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Head injuries have shown a dip in the months of November, December, and February in 2019–20 as compared to a dip in January 2018-19 [Figure 9]. In the study done by Chowduri et al.,^[9] the highest number of road accidents had occurred during the winter season (December, January, February, and March). There was a significant decrease in the number of fractures sustained in RTAs from 159/1276 (12.5%) in 2018–19 to 124/1299 (9.5%) in 2019–20, P = 0.018 (95% CL) [Table 5].

Figure 9: Month-wise distribution of head injuries sustained in RTAs under the influence of alcohol in Sep'18 – Feb'19 and Sep'19 – Feb'20

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Table 5: Distribution of RTAS Involving Fractures in Sep'18 - Feb'19 and Sep'19 - Feb'20

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The proportion of RTAs involving skull fractures decreased from 2.2% in September 18–February 19 to 1.5% in September 19–February 20, followed by facial bone fractures from 1.4% to 0.7%, upper limb fractures from 3.6% to 3.2%, and spine fractures from 0.5% to 0.4%, respectively [Table 6]. However, these differences were not found to be statistically significant, P = 0.224 (95% CL). Lower limb fractures followed by upper limb fractures were the most common in RTAs during the six-month period (September to February) in 2018–19 and 2019–20, which is similar to the findings of Ranjana Singh et al.^[10]

Table 6: Distribution of RTAS According to Anatomical Site of Fractures Sustained in Sep'18 - Feb'19 sand Sep'19 - Feb'20

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There is a statistically significant reduction in deaths of RTA cases during September 2019–February 2020 as compared to September 2018–February 2019, P = 0.000 (95% CL). Conservative management of cases has come down from 2018-19 to 2019-20. Referral to different departments like surgery, orthopedics, etc., have also come down for the corresponding period except for a marginal increase in referrals to neurosurgery from 19.1% to 19.6% [Table 7]. Similar differences were seen between the outcomes of RTAs occurring under the influence of alcohol during the above periods [Figure 10].

Table 7: Distribution of RTAS Based on the Outcomes, in Sep'18 - Feb'19 and Sep'19 - Feb'20

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Figure 10: Outcomes of RTAs under the influence of alcohol in Sep'18 – Feb'19 and Sep'19 – Feb'20

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Conclusions

There is a marked reduction in deaths of RTA cases during September 2019–February 2020 as compared to September 2018–February 2019. Simple injuries have increased in September 2019–February 2020 as compared to September 2018– February 2019.
Grievous injuries and head injuries have reduced in September 2019–February 2020 as compared to September 2018–February 2019. There is a significant decrease in number of fractures sustained in RTAs from 12.5% in 2018–19 to 9.5% in 2019–20. There is no marked difference in the anatomical distribution of fractures.
The proportion of RTAs occurring under the influence of alcohol reduced from 9.4% in 2018–19 to 8.4% in 2019–20. The fatal injuries sustained in RTAs under the influence of alcohol dramatically reduced to zero from November 2019 to February 2020, suggesting a protective effect of the new prohibition of liquor sales policy.
Conservative management of cases has come down in 2019–20 than that in 2018–19. Referrals to different departments like surgery, orthopedics, etc., have also come down for the corresponding period, except for a marginal increase in referrals to neurosurgery from 19.1% to 19.6%.

Strengths

The study has been done immediately after the introduction of prohibition policy.
Large sample size (2600).

Limitations

The study could not be continued beyond six months due to COVID-19 lockdown.
Data is secondary in nature, being collected from accident records and MLC registers, by different sets of interns/casualty medical officers.

Ethical issues

All prior permissions were taken from the Institutional Ethical Committee. Patient's anonymity was maintained by excluding the name of the patient from the data collected.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Mariano D. World Bank Blogs. Available from: https://blogs.worldbank.org/opendata/over-125-million-people-are-killed-road-each-yea. [Last accessed on 2019 Dec 26].
2.	Global Status Report on Road Safety 2018; World Health Organization. Available from: https://www.who.int. [Last accessed on 2019 Dec 26].
3.	Jaiswal AK, Krishna S, Agarwal A, Ghosh A, Pal R. Alcohol and road safety; investigation and legal aspects. AR Ameen J Med Sci 2018;11:154-60.
4.	Prohibition & Excise Policy for 2019-20 in respect of shops (retail outlets), Government of Andhra Pradesh, The Andhra Pradesh Gazette. Available from: https://www.ap.gov.in. [Last accessed on 2019 Dec 24].
5.	Road Traffic Accidents. National health portal of India. Available from: www.nhp.gov.in. [Last accessed on 2019 Dec 24].
6.	Aggarwal A. Textbook of Forensic Medicine and Toxicology, Part I, Section 3. Avichal Publishing Company; 2014. p. 205-6.
7.	Sustainable Development Goals, UNDP. Available from: https://www.undp.org. [Last accessed on 2019 Dec 26].
8.	Road Accidents in India 2018. Government of India, Ministry of Road Transport and Highways. Available from: www.morth.nic.in. [Last accessed on 2019 Dec 26].
9.	Monusha Chowdari N, Rohit BR, Souza SD. Extent of road traffic accidents in Manguluru city, Karnataka, India. J Forensic Sci & Criminal Inves 2019;11:55518. doi: 10.19080/JFSCI.209.11.555813.
10.	Singh R, Singh HK, Gupta SC, Kumar Y. Pattern, severity and circumstances of injuries sustained in road traffic accidents: A tertiary care hospital based study. Indian J Community Med 2014:39:30-4.
11.	Sanjay Karpoor, Ravishankar Kumar G, Sudhir Bhat, Umesh Avarade, Basvaraj Gagan. Effect of alcohol ban on road traffic accidents in national highways near Belgavi. Medpulse Int J Surg 2018;6:13-6.
12.	Baruah AM, Chaliha R. A study of incidence of alcohol use in fatal road traffic accidents. J Indian Acad Forensic Med 2015;37. doi: 10.5958/0974-0848.2015.00002.0.
13.	Jani CB, Gupta S, Barot H, Gandhavi J. Retrospective study of cases of Drunkenness with emphasis on procedure and interpretation of results. J Indian Acad Forensic Med 2008;29:128-35.
14.	Rao Y, Zhao Z, Zhang Y, Ye Y, Zhang R, Liang C, et al. Prevalence of blood alcohol in fatal traffic crashes in Shanghai. Forensic Sci Int 2013;224:117-22.