A Two year study of Cranio-cerebral injuries by Mechanical Violence, with special reference to Traffic Accidents in and around Madurai City: January 2004-December 2005

INTRODUCTION: Cranio-cerebral injuries has assumed paramount importance in recent times due to mechanization and industrialization. These injuries have shown an alarming rise in the recent times owing to fast modernization as a result of adaptation of man to machine and motor. Despite supreme measures in the form of sophisticated protective gadgets usage, tremendous advances in public education, the subject continues to be a major cause of mortality and morbidity. Head injury occur every 15 seconds and patient dies from head injury every 12 minutes in a day and, these injuries and account for a significant portion of health care costs today. Head is the most prominent of the exposed parts of the body by virtue of its position and is very vulnerable to trauma. AIMS AND OBJECTIVES : 1. To analyze and study the post-mortem features of head injuries cases. 2. To study the mode of trauma and the type of agent causing trauma. 3. To study the incidence of age and sex of victims involved in accidents. 4. To analyze the relationship of seasonal variations and road traffic accidents with respect to time, day and quarter of the year. 5. To study the pattern of scalp and skull injuries. 6. To study the types of different intracranial haemorrhages. 7. To study the gross features of brain damage. 8. To analyze the association of head injuries and other bodily injuries contributing towards the cause of death. 9. To analyze the cause of death. 10. To analyze the survival time and modes of intervention, if possible. 11. To deduce any preventive and safety measures if possible. In the present study there were 775 deaths due to head injury in a period of 2 years (January 2004 to December 2005). • The cases consisted of three groups of victims viz: • Victims of RTA – 77.5% (601cases), • Victims of Assault – 7.7% (60cases), • Victims of Fall – 14.8% (114cases). • Males showed a preponderance in all the categories (80.3%) and the maximum incidence was seen in 16-30 years age group in RTA and assault but in 31-45 years age group in fall. • Road traffic accidents showed highest peak in the month of April, and a second peak in the month of May and December. Assault and fall incidences were more or less equally spread throughout the year. • Majority of RTA deaths involved vehicle occupants (42%) followed by drivers (30%) and pedestrians (28%). • 74.2% of the victims succumbed within 24 hours of accident. • 51.4% cases showed scalp contusions and 46.6% cases showed lacerations of scalp. • 45% (351 cases) showed skull fracture out of which 69% were vault fractures and the rest 31% were basal fractures. 44.7% (157)cases showed linear fractures, 11% (40 cases) depressed fractures,and comminuted fractures. • 596 cases (77%) showed intracranial haemorrhages. Out of which 95 (16%) were extradural, 260 (33.5%) were sub-dural, 129 (21.6%) sub-arachnoid and 112 (18.8%) parenchymal hemorrhahges. • 87 cases (88%) of extra-dural haemorrhage was associated with skull fracture and only 12% not associated with any skull fracture. • Subdural haemorrhage does not have any significant association with presence or absence of skull fracture though it appears to be more with skull fracture. • Presence of subarachnoid haemorrhage with all the other injuries to the head provides a stronger evidence of trauma. • 60% (192) contusions and 40% (128) lacerations were seen in brain. 67% were coup contusions and 33% contre-coup contusions. • Contusions were most common in multiple sites (37.5%), frontal (20.3%) and parietal lobes (16.7%) followed by occipital (15.6%)and temporal (9.8%) lobes. • Lacerations were maximum in frontal lobes (55.8%), followed by parietal (18.8%), temporal (17.4%) and occipital lobes (7.8%). Multiple site lacerations were seen in 63.2% cases. • Majority of the head injuries in road traffic accidents was associated with other bodily injuries. In 250 cases facial injuries, in 308 cases chest injuries, in 253 cases abdominal injuries and in 426 cases limb injuries were seen. Lung, liver and spleen injuries played a major role in compounding to the mortality of these cases. • The primary causes of death in head injury were Haemorrhage, Neurogenic shock and Diffuse axonal injury. Equally significant was other secondary causes like bronchopneumonia, infection, herniation and cerebral compression, renal failure and crush syndrome