| Objective:We aimed at studying the injury characteristics of autopsied vicitms caused by road traffic accidents (RTAs) over the past13years in the main city districts of Hangzhou, and analyzing the direct cause to death, thereby presenting scientific evidences to prevent from road traffic collisions (RTCs), improve the post-crash care and reduce more avoidable deaths.Methods:This retrospective cross-sectional study was systematically conducted in eight main city areas of Hangzhou during the past13years (January1,2000-December31,2012) relying on the data from autopsy reports.Results:Overall, Hangzhou witnessed2923autopsy fatalities over the past13years. Road traffic deaths predominately affected the following populations:males (67.24%,1,964/2,921), the young-age (50.23%,1,450/2,887), workers (49.61%,1,450/2,923), pedestrians (33.39%,973/2,914) and bicycles-and-tricycles’users (40.63%,1,184/2,914). There were two time peaks of fatal RTCs happened at06:00-07:59(11.67%,341/2923) and18:00-21:59(21.42%,626/2923). The overwhelming majority of accident vehicles were large-/medium-sized trucks (36.90%,1,073/2,908). Victims with multiple injuries accounted for59.35%(1,724/2,905), especially two parts of injured body (45.82%,790/1,724). The most single injured body regions from RTCs belonged to head (80.90%,2,350/2,905). The median of ISS were75(0-75), and GCS were3(3-15). Severe injury and severe craniocerebral injury accounted for99.28%(2,894/2,915) and83.23%(2,432/2,922), respectively. Following factors were related to injured body regions and the classification of GCS significantly after univariate analysis:the age groups of victims, deceased’s traffic manners, accident vehicles and the pattern of crash. And following factors were related to the classification of ISS significantly after univariate analysis:the age groups of victims, accident vehicles and the pattern of crash. After the multivariate Multinomial Logistic Regression, the above-mentioned factors were independently related to the injured body regions, the classification of ISS and GCS as following:compared with users of large-/medium-sized trucks, that of bicycle-and-tricycles was more prone to present single craniocerebral injury rather than multiple injuries (OR=1.78,95%CI:1.11-2.86), and victims involving pedestrains (OR=0.08,95%CI:0.01-0.96) was inclined to occur multiple injuries instead of single site of injury with upper and lower limbs injury; that of mini-cars (OR=2.25,95%CI:1.19-4.27) and mini-trucks (OR=2.67,95%CI:1.28-5.58) was more prone to present13<GCS<15rather than3<GCS<8. Compared to large-/medium-sized trucks, other types of accident vehicles were less likely to be single injury with head rather than multiple injuries; accident vehicles involving motorcycles (OR=0.24,95%CI:0.10-0.57), mini-cars (OR=0.52,95%CI:0.39-0.70) and mini-trucks (OR=0.54,95%CI:0.36-0.80) were most likely to creat3<GCS<8rather than13<GCS<15; bicycles-and-tricycles (OR=2.52,95%CI:1.00-6.32) and mini-cars (OR=1.73,95%CI:1.02-2.95) were more inclined to be9<GCS<12rather than3<GCS<8. Compared with frontal crash, rear-end crash (OR=0.63,95%CI:0.44-0.90) and roller compaction (OR=0.37,95%CI:0.26-0.54) were more inclined to multiple injuries rather than single craniocerebral injury, but motor vehicle crash with immovable object more inclined to single injury with chest rather than multiple injuries (OR=3.02,95%CI:1.11-8.25); rear-end crash (OR=2.18,95%CI.1.51-3.14) were more inclined to be13<GCS<15rather than3<GCS<8; rear-end crash (OR=2.18,95%CI:1.51-3.14) and roller compaction (OR=0.33,95%CI:0.12-0.92) were more inclined to be3<GCS<8rather than9<GCS<12.. Comprised with the older victims, nonage was more prone to occur single abdomen injury rather than multiple injuries (OR=7.28,95%CI:1.25-42.55); nonage (OR-0.11,95%CI:0.02-0.82) and the young (OR=0.11,95%CI:0.02-0.82) was more prone to occur3<GCS<8rather than9<GCS<12. Comprised with the older victims, the young-age was more prone to occur ISS>25rather than ISS<16(OR=0.13,95%CI:0.03-0.60).39.21%(1,146/2,923) of autopsied victims died at intensive care units (ICU), following at emergency department (ED)(31.65%,925/2,923) and at pre-hospital (29.15%,852/2,923). The top three time segments occurring death after RTAs was1.0-6.0h (28.40%,597/2,102)),168.0-720.0h (23.98%,504/2102), and0-1.5h (18.22%,383/2102), respectively. The predominant direct cause to death at pre-hospital or at ED was respiratory accompanied circulatory failure (RCF), accounting for89.91%(766/852) and81.08%(750/925), respectively; and infection complicated with MODS (65.36%,749/1,146) was the most direct cause to death at ICU.Conclusion:The main features of fatal road traffic injuries were multiple injuries and craniocerebral injury. The predominant direct cause to death was acute RCF at the early stage after RTAs, and the most direct cause to death at ICU was infection complicated with MODS. Therefore, by establishing a team experted at traum and critical care medicine, heightening the ability on distinguishing, treating with fatal injuries for the first-witness, relieving the threat on RCF at the early stage, preventing and controlling the infection for critically ill patients at ICU may be effectively reduce deaths caused by car accidents. |
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