ANALYSIS OF HEAD INJURY IN VICTIMS OF TWO-WHEELER ACCIDENTS - AN AUTOPSY BASED STUDY

Background:Road traffic accidents are one of the leading causes of death globally. They are also a major contributor to the global burden of diseases and can have both social and economic consequences. Motorcycle crash victims make up the majority of those killed or injured in road traffic accidents worldwide. Head injuries are a common cause of severe morbidity and mortality in motorcycle crashes. This has prompted many studies to investigate the reasons behind the high percentage of motorcycle accidents. Rash driving, speeding, helmet usage, and non-compliance with traffic laws are some key contributing factors. The study aims to analyze the pattern of head injuries sustained by motorcyclists in road traffic accidents. Material and Methods:The victims of two-wheeler accidents were brought for post-mortem examination at the Department of Forensic Medicine, Medical College, Kozhikode. The victims details were collected from the police request, and the accident details were collected from the police and the witnesses /relatives. If treated, details were collected from the case sheet and CT findings. All the injuries were recorded and photographs were taken. Results:The study group was 135 victims of fatal two-wheeler accidents. It includes 127 (94.1%) males and 8 females (5.9%). The mean age of the victims was 33.57 with a standard deviation of 13.83. Head injury was the lone cause of death in 67 cases (49.60%, 95% CI - 41.32 - 57.96) followed by a combination of head and chest injury in 15 cases (11.10%) with 95% CI6.85 - 17.52. There were 39 cases (28.88%) where the head injury was a contributing factor to the cause of death, thus making a total of 106 head injury cases (78.51%). Common scalp injury was contusion 84 cases (62.20%) and the common site involved was the temporoparietal region 14 cases (10.37%). Fissured fracture of the base was the commonest skull fracture with 49 cases (36.3%, 95% CI - 28.67 - 44.69) followed by fissured fracture of the skull vault 44 cases (32.59%, 95% CI - 25.26 - 40.88). The commonest site of skull vault fissured fracture was in the right temporoparietal region in 15 cases (11.11%). Subarachnoid hemorrhage (SAH) was the most common single intracranial hemorrhage, in 28 cases (26.40%), with 95% CI 18.96 - 35.53, followed by a combination of subdural (SDH) and subarachnoid in 19 cases (17.90%). SAH was associated with other intracranial hemorrhages in 63 cases (59.43%). In total SAH was found in 98 cases (92.45%) with 95% CI 85.81 - 96.12. Coup contusion was mostly seen in the right temporal and right temporal-parietal regions in 6 cases each (4.44%). The commonest site of contrecoup contusion was the left temporal region with 10 cases (9.43%). Secondary brain stem hemorrhage was seen in 29 cases(27.36%) with 95% CI 19.78 -36.53. Conclusion: In the present study, the most common injury leading to death was head injury. This reiterates the importance of wearing helmets by motorcyclist riders. It is the younger age group that is affected the most which emphasizes the importance of safe driving and adhering to good driving habits. Subarachnoid was the major intracranial hemorrhage followed by subdural and basal skull fracture was the predominant fracture.