"Unintentional Injury” A descriptive analysis of 8,092 Emergency admissions Dr. Srihari Cattamanchi Post Graduate
"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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