"Unintentional Injury” A descriptive analysis of 8,092 Emergency admissions

Dr. Srihari Cattamanchi

Post Graduate Resident M.D. Accident & Emergency Medicine

Leading Causes of Death World Wide

Objectives• Assess contribution of unintentional injuries

to overall burden in Emergency department.

• Determine incidence, population at risk & other characteristics of unintentional injury.

• Identify areas where intervention is needed, where it might be possible to reduce public health costs by preventing injuries.

 Methods• Study design: Prospective, descriptive, analytical study.

• Setting: Accident & Emergency department, CMC - Vellore, India.

• Duration: 1 Year – 1st August 2006 to 31st July 2007.

• Study Population: All injured patients attending emergency with unintentional Injury.

Methods (Cont..)

• Sampling technique: Consecutive sampling.

• Sample Size: 8,092 patients.

• Instrument: Pre-formatted Questionnaire.

Operational Definitions

Injury

A bodily lesion at the organic level, resulting from acute exposure to physical energy in amounts that exceed the threshold of physiological tolerance.

* W.H.O. 2002.

MethodologyInclusion criteria:

All patients registered with injury to emergency due to Unintentional Intent.

Exclusion criteria: a. Old Injuries b. Burns

RESULTS - Patient profile

August

September

October

November

December

January

February

March

April

May

June

July

0 500 1000 1500 2000 2500 3000 3500 4000

740

723

728

702

769

745

740

759

790

728

720

723

2628

2419

2420

2181

2097

1848

2235

2424

2810

2595

2248

2252

Injury 8,823 Other Illness 28,156No of Patients

Mon

ths

Aug

ust 2

006

- Ju

ly 2

007

N = 36,97924.3%

21.2%

21.9%

23.8%

24.8%v

28.7%

26.8%

24.3%

22.7%

23%

21.1%

24.2%

Intent of Injuryn = 8,823

8092

669

62

Unintentional 91.7%Suicidal 7.3%Homicidal 1%

Injury - Frequency, Percentage & Crude Rates

Cause of Death Frequency Percentage Rate per 10,000

populationUnintentional Injuries

Road Traffic Accident 4406 54 % 1182

Fall 1799 22 % 481

Industrial Accidents 1099 13 % 295

Violence related Injuries

Suicidal 775 9 % 209

Homicidal 159 2 % 42

All Injuries 8823 24 % 2385

Aetiology of Injury

Road traffic Accidents

Falls

Industrial Ac-cidents

Poison

Assault

Others

Hanging

0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000

n = 8,8230.6%

2%

6.7%

22%

54%

1.7%

13%

Weekly distribution of Injury

16%

13%

12%

14%

13%

15%

15%Sunday 1430Monday 1170Tuesday 1091Wednesday 1258Thursday 1182Friday 1364Saturday 1328

n = 8,823

Injury – Triage priority

Priority 1 Priority 2 Priority 30

500

1000

1500

2000

2500

3000

3500

4000

4500

FemaleMale

Inju

ries

n = 8,823

Priority 1: Life - threateningPriority 2: Potential Life - threateningPriority 3: Non – Life - threatening

8%

44% 48%

Injury - Age and Gender Distribution

0 - 9

10 - 19 y...

20 - 29

30 - 39

40 - 49

50 - 59

60 - 69

70 - 79

> 80

0200400600800

10001200140016001800

FemaleMale

Age

Inju

ries

n = 8,823

Injury - Place of Occurrence

Fields Home School Street Work Total

Female 44 995(48%)

60 726 (35%)

202 (10%)

2063(25.5%)

Male 214 1661 (27%) 30 3444

(57%)680 (11%)

6760(74.5%)

Total 258 2656 (33%) 90 4170

(51%)882 (11%) 8823

Activity during Injury

3996

1551

1391

794

531

Travelling 49%

Walking 19%

Working 17%

Playing 9%

Others 6%

n = 8,823

Road Traffic Accidents

RTA - Age and Gender

0 - 9 10 - 19

years

20 - 29

30 - 39

40 - 49

50 - 59

60 - 69

70 - 79

> 800

200

400

600

800

1000

1200

FemaleMale

Inju

ries

n = 4406

RTA – Mechanism of Injury

Skid and Fall

Motor Ve-hicle Colli-

sion

Pedestrian Bicycle0

200400600800

100012001400160018002000

1882

1686

691

221

Inju

ries

n = 440642%

38%

15%

5%

RTA - Victim profile

Rider Driver Passenger Pedestrian Cyclist0

500

1000

1500

2000

2500

MaleFemale

56%

20%

26%

16%

4%

n = 4406

RTA – Vehicle Involved

2 Wheeler

4 Wheeler

Pedestrian

AutoBicycle

0

500

1000

1500

2000

2500

3000

FemaleMale

57%

23%16%

5%9%

n = 4406

Injuries due to Fall

Profile of Injuries due to fall

Slip and Fall

Fall from Height < 1

meter

Fall from Height > 1

meter

Fall from Stairs

0

200

400

600

800

1000

1200

Female 118Male 288

59%

12%6%

n = 1799

23%

Injury due to Fall - Gender and Age

0 - 9 10 - 19 years

20 - 29 30 - 39 40 - 49 50 - 59 60 - 69 70 - 79 800

50

100

150

200

250

300

350

FemaleMale

n = 1799

• Pre Event Sign Boards (wet floor, Under Repair, Men at

Work)Drunken DrivingTraffic Rules

• Event Seat Belts & HelmetsSafety Measures & Gears at Work

• Post Event First AidProper Immobilization & TransportPre-Hospital Care

• Community Education

Unintentional Injuries – Areas of InterventionHaddon’s Phases of Prevention

Injury Severity Score

Clinical Injury No. of Patients Mean ISS

Single system 3234 (36.66%) 16.32 ± 8.69

Double systems 3470 (39.33%) 21.63 ± 9.53

Multiple systems 2117 (24.00%) 30.93 ± 12.83

The overall mean ISS was 21.12 ± 10.30.

• Mean duration of presentation to ED is 3.79 ± 44.75 hrs.

• Nearly 23% of patients presented within the “Golden Hour” (Mean - 0.46 ± 0.28hrs).

• Mean Duration of stay in the Emergency Department was 8.31 ± 5.67 hours.

Results (cont..)

Disposition after Initial Treatment

Discharged 4587

Admitted 2735

DAMA 1389 Expired 1120

500100015002000250030003500400045005000 n = 8,092

31%

52%

12%

1.28%

Injury Pyramid

n = 8,0921

Death

24Hospitalised

41Treated and Discharged

CONCLUSION• About 24% presented with injuries to emergency.

• Unintentional injuries accounted for 92% of all injuries.

• Road traffic accidents were 54%.

• Male predominance was 74.5%.

• Half of them belonged to 2nd & 3rd decade of life.

• Nearly 23% patients arrived within “Golden Hour”.

• Length of stay in ED was between 3 to 13 hrs.

• Injury accounted for 2,80,862 YPLL.

• Increase of one system injury – ISS jumps by 8.

• Death rate of 1.28% was observed.

CONCLUSION

Benefit of the Study• Quantitative insight into injury load on the

emergency department and on the society.

• Developing injury registry.

• Developing efficient pre-hospital care programs.

• Scope for societal education of injury prevention.

Prevent injuryfor

Better Health

Thank You

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