Road traffic collisions (RTCs) are a leading cause of morbidity and mortality worldwide, posing a significant public health challenge. Fatal road traffic collisions not only cause personal and familial distress but also place a considerable burden on healthcare systems, legal frameworks, and economies globally. Every day, there is a rise in the number of traffic accidents that result in fatalities or injuries that render people unable to work. This presents a significant challenge to the public health sector for the prevention of such incidents. A. When a car collides with another vehicle, a person, an animal, debris on the road, or any other stationary object, such as a tree, pole, or building, this is known as a traffic collision. Motor vehicle collisions frequently result in injuries, disabilities, fatalities, and damage to property, in addition to monetary losses for both society and the individuals who are involved in the incidents. Road transportation is the most perilous circumstance that individuals face on a daily basis; nonetheless, the number of casualties that occur as a result of such occurrences receives less attention from the media than other forms of tragedies that occur less frequently [1]. It was estimated that 54 million people around the world were injured as a result of traffic collisions in 2013 [2]. This led to 1.4 million deaths in 2013, which is an increase from the 1.1 million deaths that occurred in 1990 [2]. Of these, almost 68,000 were found in children who were younger than five years old [3]. The majority of nations with low incomes are experiencing an increase in the number of deaths that are caused by traffic crashes, whereas almost all countries with high incomes are experiencing a decrease in death rates. Countries with a middle income have the greatest rate, with 20 deaths per 100,000 inhabitants. These countries account for 80 percent of all fatalities that occur on the roads, and they have 52 percent of all vehicles. While the death rate in Africa is the greatest (24.1 per 100,000 inhabitants), the death rate in Europe is the lowest (10.3 per 100,000 inhabitants) [4]. Africa in particular has the highest death rate. More than 85 percent of all deaths and 90 percent of disability-adjusted life years were lost owing to road traffic injuries in developing nations [5]. Road traffic accidents are a severe public health hazard in these countries, where they are responsible for more than 85 percent of all deaths combined. Road crashes were responsible for 464,674 collisions in India, which resulted in 148,707 deaths that were reported as being due to traffic. It was claimed that the three states with the highest overall numbers of fatalities were Uttar Pradesh, Maharashtra, and Tamil Nadu. Together, these three states accounted for around 33 percent of the total number of fatalities that occurred in Indian traffic in 2015 [6]. There are a number of factors that contribute to road traffic collisions; nevertheless, it is vital to have an awareness of the factors that are responsible for the deaths of the victims in order to not only prevent fatalities but also prevent road traffic collisions. Autopsy studies are essential for understanding the patterns, mechanisms, and contributing factors of fatal road traffic collisions. They provide detailed insights into the types and severity of injuries sustained, along with their relationship to variables such as crash dynamics, vehicle type, and human factors. These studies are critical for forensic investigations, public safety initiatives, and policymaking.

This study aimed to analyze the patterns of fatal injuries in road traffic collisions based on autopsy findings. By systematically evaluating cases, it seeks to uncover key trends and identify preventive measures that can reduce the occurrence and severity of such incidents.

This is a retrospective study, that was carried out over a one-year duration from date 01/01/2023 to 31/12/2023 in the Department of Forensic Medicine and Toxicology, Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, India. This tertiary care teaching hospital chiefly caters to the demands of the rural area of Muzaffarpur and adjacent districts of Bihar.  

Inclusion Criteria:

1. Autopsy Reports: Cases with complete and documented autopsy reports related to fatal road traffic collisions.
2. Cause of Death: Cases where death was directly attributable to road traffic collisions as determined by forensic experts.
3. Victim Types: All categories of victims, including drivers, passengers, pedestrians, cyclists, and motorcyclists, are included in road traffic accidents resulting from collisions with motorcycles, light motor vehicles, and heavy motorcycles.

Exclusion Criteria:

1. Incomplete Data: Cases with missing, incomplete, or inconclusive autopsy reports or associated documentation.
2. Non-Traffic-Related Deaths: Deaths caused by factors unrelated to road traffic collisions (e.g., natural deaths, suicides, or homicides).
3. Postmortem Decomposition: Cases where advanced decomposition of the body made accurate injury assessment impossible.
4. Non-Fatal Outcomes: Cases involving individuals who survived the collision but later succumbed to unrelated medical conditions.

5. Railways and railway traffic collision deaths.

All data were obtained from the autopsy report, hospital records, and police documents. The collected data were entered in a standardized format and analyzed. The collected data was recorded in a master chart and analyzed using statistical software, SPSS Statistics 18, and Microsoft Office Excel 2021. The analysis was performed to calculate percentages and proportions. The observations were systematically organized and presented in tabular format.

During the study period, 1,410 autopsies were conducted. Road traffic accidents contributed 42.91% (n=605) of the total autopsies performed (Figure 1). Incidence was more common among males [502 (82.97%)] compared to females [103 (17.03%)] (Figure 2).

Figure 1: Showing the distribution of the total number of autopsies during the study period

Figure 2: Showing the gender distribution of the victims in the road traffic accidents

Table 1: Showing the distribution of age and gender among fatal road traffic accident victims.

The analysis of fatal road traffic accident victims shows a significant male predominance, with males comprising 82.97% (502 cases) and females 17.03% (103 cases) of the total 605 victims. The age group of 31–40 years recorded the highest number of fatalities, with 220 cases (36.36%), followed by the 21–30 age group with 127 cases (20.99%) and the 41–50 age group with 110 cases (18.18%). Fatalities progressively declined in the older age groups, with only 50 cases (8.26%) in the 51–60 age range, 19 cases (3.14%) in the 61–70 age range, and 2 cases (0.33%) in the 71–80 age range. No fatalities were reported in the 81–90 age range. Across all age groups, males consistently outnumbered females, with the largest gender disparity observed in the 31–40 age group (182 males vs. 38 females). These findings underscore that the most vulnerable demographic is males in their productive age range of 21–50 years, highlighting the need for targeted road safety interventions and public health strategies to reduce fatalities in this group.

Table 2: Showing the distribution of types of vehicles responsible for fatal road traffic accidents.

Light motorcycles were most commonly involved in fatal traffic accidents, making up 46.12% (279 cases) of the 605 total accidents, according to an examination of vehicle categories involved in these incidents. The second most frequent category was motorbikes, accounting for 28.26% (171 incidents), followed by heavy motorcycles, which accounted for 25.62% (155 instances). These results underline the need for focused safety measures and interventions for this vehicle category by showing that light motorbikes bear a disproportionately high burden of fatal traffic incidents.

Table 3: Showing the different body parts injured as a result of impact in the fatal road traffic accidents.

The analysis of injuries sustained in fatal road traffic accidents reveals that the head and neck region is the most frequently affected area, with a total of 411 cases: 316 males and 95 females. Following this, chest injuries were documented in 302 cases (280 males and 22 females), and abdominal injuries accounted for 230 cases (216 males and 14 females). Injuries to the pelvis and spine occurred in 163 cases (153 males and 10 females), while lower limb injuries were reported in 205 cases (166 males and 39 females). Upper limb injuries appeared in 151 cases (116 males and 35 females). Furthermore, the gender distribution shows that males are disproportionately affected across all injury categories, highlighting the necessity for tailored strategies to address the elevated risk among male road users.

Table 4: Showing the distribution of different types of fatal injuries reported in fatal road traffic accidents.

The analysis of fatal injuries from road traffic accidents indicates that head injuries, especially cranio-cerebral injuries, were the most common, comprising 520 cases (85.95% of the total). Liver lacerations accounted for 254 cases (41.98%), while lung/diaphragm lacerations were observed in 156 cases (25.79%). Additional notable injuries comprised spinal injuries (169 cases, 27.93%), rib fractures (139 cases, 22.98%), and lacerations of major vessels (72 cases, 11.9%). In contrast, cardiac injuries (49 instances, 8.10%), splenic lacerations (42 cases, 6.94%), and renal lacerations (24 cases, 3.97%) were less prevalent. Crush injuries to the head, chest, and abdomen were recorded, with 30, 24, and 12 occurrences correspondingly. The high incidence of head injuries highlights the urgent need for increased helmet use and improved vehicle safety technologies to reduce the death rate associated with traumatic brain injuries.

Table 5: Showing the distribution of the different nature of blunt injuries reported in fatal road traffic accident victims.

The analysis of blunt injuries among victims of fatal road traffic accidents reveals that abrasions were the predominant injury type, observed in all 605 cases (100%). In 487 cases (80.50%), abrasions and contusions, encompassing both surface and organ contusions, were observed, indicating their notable prevalence in these incidents. Lacerations, impacting both the surface and internal organs, were documented in 351 cases (58.02%), whereas fractures were recorded in 283 cases (46.78%).

The findings reveal a high occurrence of superficial injuries, including abrasions and contusions. Additionally, many victims suffer from more serious injuries, such as lacerations and fractures.

Table 6: Showing the duration of admission and cause of death in the victims of fatal road traffic accidents.

The duration of hospital admissions and the causes of mortality among victims of fatal road traffic accidents show varied outcomes. Traumatic shock was identified as the primary cause of death for 211 individuals (34.88%), with the majority either dying at the scene of the accident or being pronounced dead upon arrival at the hospital. Head injuries and exsanguination were the second most prevalent causes of death, accounting for 151 cases (24.96%), with fatalities occurring within 12 hours of admission. Complications from head injuries, pneumothorax, and secondary hemorrhage led to the deaths of 85 victims (14.05%) within a 24-hour period. In the following days, 42 victims (6.94%) died from septicemia related to head injuries, while 36 victims (5.95%) succumbed to embolism, deep vein thrombosis, or pulmonary embolism within 5 to 7 days post-admission. Additionally, 73 victims (12.07%) passed away after 7 days due to complications such as renal failure, septic shock, lung infections, or peritonitis. These findings highlight the critical importance of prompt trauma care for individuals with severe head injuries and underscore the necessity for effective post-trauma management to reduce complications like septicemia, embolism, and organ failure, which can lead to mortality in the days following the incident.

The present study examines the patterns and epidemiological characteristics of fatal road traffic collisions (RTCs) in Muzaffarpur, Bihar. The findings underscore the global burden of road traffic injuries as a significant public health issue, particularly in low- and middle-income countries like India. Muzaffarpur, a rapidly growing city in Bihar, experiences a blend of urban and rural traffic conditions. Conducted from January 2023 to December 2023, this study analyzed a total of 1,410 road traffic accident cases, which accounted for 42.91% of all autopsies performed during the study period. In a related study by Sachin et al. [7], road traffic accidents comprised only 263 out of a total of 1,467 autopsies. In our study, males constituted 82.97% (n=502) of the victims, a finding consistent with observations made by researchers in other studies [7-11]. This highlights the active role of males in the population, indicating their higher mobility and preference for vehicle use. It also reflects a traditional inclination for males to engage in outdoor activities. The study found that the majority of victims were in the age group of 31-40 years, accounting for 36.36% (n=220) of the cases. This finding supports the conclusions of Aubakirova A et al. [12], although it contrasts with observations from other studies [10-13], which reported that most victims were aged 21-30 years. This discrepancy may be attributed to individuals in their thirties being more established in their careers, often having the financial means to purchase vehicles, while those in their twenties are typically still focused on education or training. Moreover, our results indicate that the most active age group, which is engaged in professional competition, is affected the most. The least affected age groups included children under 10 years and seniors over 70 years, further supporting these observations. Our study also revealed that light motor vehicles were the leading cause of accidents, representing 46.12% (n=279) of cases. This finding contrasts with Sachin et al. [7], who noted that motorcycles were responsible for 78.3% of accidents. The difference may be due to the rising costs of motorcycles; a new motorcycle can be as expensive as a second-hand light motor vehicle. Furthermore, many affordable small cars are now manufactured to cater to the middle-class demographic, which makes up 60% of the population.

We observed that the head and neck injuries were the most affected regions in 411 cases. Chest injuries were noted in 302 cases, and abdominal injuries were present in 230 cases. Similar observations have been made in other studies [10-16], where head injuries were reported in 67.39% of victims. This is likely due to the weight of the head (5-7 kg), its eccentric position relative to the spine, and its greater mobility compared to other body parts.

In a study conducted by Abhishek et al. [17], the abdomen was identified as a major injured region, which contrasts with the findings of the present study and other research [14-18]. These discrepancies warrant careful verification and analysis to understand the differences observed, although multiple regions of injury, which were not part of this study, may also play a role. The most severe injuries reported in our study were head or craniocerebral injuries, accounting for 85.95% of cases, consistent with findings from other studies [7-19]. In a similar study by K. Deepak et al. [20], hemorrhagic shock was identified as the primary cause of death. This raises an important debate, as the ICD-10 classification does not recognize hemorrhagic shock as a cause of death; instead, it is considered a mechanism of death. Other potential causes include multiple injuries due to involvement of the chest, abdomen, and extremities. Another significant finding from the present study is that all victims (100%) exhibited abrasions on their bodies. This confirms that abrasions are a common characteristic of road traffic collision victims, resulting from blunt force impact and contact with rough road surfaces. However, this finding contrasts with the observation made by Sachin et al. [7], who reported abrasions in only 29.8% of cases. The proportions of other injuries such as contusions, lacerations, and fractures reported in the present study were similar to those found in other studies, with minor variations [20,21].

An analysis of the survival duration or treatment of road traffic collision victims and the autopsy results in our study revealed that the majority of deaths were due to traumatic shock, reported in 34.88% (n=211) of on-the-spot deaths or victims who were brought in dead. The most common causes of death after seven days of treatment included septicemia, lung infections, peritonitis, and coma. Most deaths occurring within 24 hours were attributed to complications from head injuries, pneumothorax, and secondary hemorrhage. These observations align closely with those made by Sachin et al. [7], although their study did not specify the post-mortem causes of death. These findings will assist medical establishments and clinicians [22] in understanding the fatal processes involved at the time of accidents. There are similar studies based on autopsy findings that are used for clinical audits of trauma systems and to accurately gather data for determining the actual causes of death [23,24]. Thus, the results of this study underscore the importance of having an efficient surgical team and adequate neurosurgical trauma care centers equipped with sophisticated radiological facilities. These measures are crucial for addressing the emergency needs that can reduce mortality and morbidity associated with road traffic fatalities. Therefore, this study highlights the necessity of understanding the fatal consequences of road traffic collisions, which are a major public health issue responsible for a significant number of fatalities today.

The present study highlights the critical need for a multi-faceted approach to mitigate the burden of road traffic collisions in Muzaffarpur city of Bihar state of India. By integrating robust road safety measures, public health campaigns, and advanced trauma care systems, policymakers and healthcare providers can effectively address this growing public health issue. The findings emphasize the importance of continued research and collaboration to improve road safety and reduce road traffic collision-related fatalities

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