Ulaşım yaralanmaları sonrası meydana gelen ölümlerde travma bulgularının değerlendirilmesi

Yıl 2021, Cilt: 35 Sayı: 3, 138 - 161, 31.12.2021

Merve Temel Dağ Murat Nihat Arslan Mehmet Ali Dağ Cemalettin Makca

https://izlik.org/JA42DA36ZU

Öz

AMAÇ: Bu çalışmanın amacı ulaşım yaralanmalarında meydana gelen ölümleri değerlendirmek ve kişilerin kaza anındaki yeri ile yaralanmanın ağırlığı ve lokalizasyonu arasındaki ilişkiyi belirlemektir. YÖNTEM: Adli Tıp Kurumu Morg İhtisas Dairesi’nde 01.12.2019-30.11.2020 tarihleri arasında ulaşım yaralanmaları nedeniyle otopsisi yapılan 340 vakanın verileri incelenmiştir. BULGULAR: Vakalardaki erkek kadın oranı 4,2: 1, yaş ortalaması 39,9±20,3’tür. Erkeklerin ve motosikletlilerin yaşları daha küçüktür. Vücut sıvılarında etil alkol saptanan kişilerde travma skorları ISS ve NISS puanları daha yüksektir. En sık görülen grup yaya ve motosikletliler olup bunlarda kafa kırıkları daha fazla görülmektedir. Yayalarda bölgesel olarak batın ve ekstremite yaralanması, kırıklar arasında da pelvis kırıkları diğer gruplara göre daha fazla görülmüştür. Ön koltuk yolcuları ve sürücülerin ISS ve NISS puanları daha yüksektir. Otobüs-minibüs yolcularında yaşamla bağdaşmayan masif göğüs yaralanması anlamlı olarak yüksektir. Tır içinde olan vakaların ISS ve NISS puanları anlamlı olarak daha düşüktür. Yayalara çarpan araç otobüs-minibüs ve kamyon-kamyonet olduğunda yaşamla bağdaşmayan beyin sapı yaralanmaları, motosiklet çarpmalarında ise baş bölgesi yaralanmaları anlamlı olarak daha yüksektir. SONUÇ: Ulaşım yaralanmalarını azaltıcı stratejileri belirlemek, travma lokalizasyon ve ağırlığını belirlemek, etkin tanı ve tedavi uygulamak için başta kaza anındaki konum ve araç tipi bilgileri olmak üzere yaralanmaya etki eden faktörlerin bütüncül bir yaklaşımla tespit edilmesi gerekmektedir.

Anahtar Kelimeler

Ulaşım kazaları , otopsi , yaralanma ağırlığı , travma skoru , alkol

Evaluation of traumatic findings among cases died due to transportation injuries

https://izlik.org/JA42DA36ZU

Öz

INTRODUCTION: The objective of this study was to evaluate deaths occurring in transportation injuries and to determine the relationship between the location of the persons at the time of the accident and the severity/localization of the injury. METHODS: The data of 340 autopsy cases due to transportation injuries which performed between 01.12.2019 and 30.11.2020 at the Morgue Department of Forensic Medicine were analyzed. RESULTS: The male to female ratio in the cases was 4.2: 1, and the average age was 39.9 ± 20.3. Men and motorcyclists were younger in age. Trauma scores ISS and NISS scores were higher in people with ethyl alcohol in their body fluids. The most common group was pedestrians and motorcyclists, and cranial fractures were more common in these groups. In pedestrians, abdominal and extremity injuries and pelvic fractures were more common than other groups. Front-seat passengers and drivers had higher ISS and NISS scores. Massive chest injuries, one of the unsurvivable injuries, were significantly higher in bus-minibus passengers. The ISS and NISS were were significantly lower in the truck collision cases. Brainstem injuries one of the unsurvivable injuries were higher in pedestrians in which hit by bus-minibus or a truck-van. When hitting vehicle was a motorcycle, head injuries were significantly higher. CONCLUSION: To determine strategies to reduce transportation accidents, detect the severity and localization of the trauma, provide appropriate diagnosis and to give effective treatment, it was crucial to define the factors affecting the injury including the localization of the deceased in the vehicle at the time of the accident, and vehicle type information with a holistic approach..

Anahtar Kelimeler

Transportation accidents , autopsy , injury severity , trauma score , alcohol

Kaynakça

• Alkan N, Sözen Ş. Medical and legal aspect of precau- tions to be taken against transport causalities and deaths. Turk- ish J Trauma Emerg Surg. 1999;5 1 :1–6.
• Gören S, Subaşı M, Tıraşçı Y, Kaya Z. Deaths Related to Traffic Accidents. J Foren Med. 2005;2 1 :9–13.
• Balcı M, Gölcük A, Kahramanlı H. Investigation of Re- lationship Between Death And Injury Status And Defective El- ements In Traffic Accidents By Statistical Approach. Journal of Selcuk-Technic. 2017;16 3 :210-25.
• World Health Organization, News, Road traffic inju- ries, 7 February 2020, [cited 2021 23.01.2021] Available from: https://www.who.int/news-room/fact-sheets/detail/road-traf- fic-injuries.
• World Health Organization Global Status Report on Road Safety, 2018, [cited 2021 23.01.2021] Available from: https://www.who.int/publications-detail/global-status-report- on-road-safety-2018.
• Türkiye İstatistik Kurumu Karayolu Trafik Kaza İstatistikleri, 2019 [cited 2021 23.01.2021] Available from: https://data.tuik.gov.tr/Bulten/Index?p=Karayolu-Trafik-Kaza-Istatistikleri-2019-33628 [in Turkish].
• Pakiş I, Turan AA, Kareyel F, Akyıldız E, Ersoy G, Üstündağ KT, Çetin G. Abdominal And Pelvic Trauma In Traf- fic Accidents; An Autopsy Study. Journal of Forensic Medicine. ;22 1 :31-35.
• Korur Fincancı Ş. Trafik kazalarında ortaya çıkan adli tıp sorunları. Adli Tıp Bülteni. 1996;1 1 :26-28 [in Turkish].
• Özdemir Ç. Trafik kazaları ve bilirkişilik. Birinci Basa- makta Adli Tıp. 2011; 81-92 [in Turkish].
• Greenspan L, McLellan BA, Greig H. Abbreviated Injury Scale and Injury Severity Score: a scoring chart. J Trauma. 1985 Jan;25 1 :60–4.
• Rautji R, Bhardwaj DN, Dogra TD. The Abbreviated Injury Scale and its correlation with preventable traumatic accidental deaths: a study from South Delhi. Med Sci Law. 2006 Apr;46 2 :157–65.
• Türk Ceza Kanunu’nda Tanımlanan Yaralama Suçlarının Adli Tıp Açısından Değerlendirilmesi Rehberi. Adli Tıp Uzmanları Derneği-Adli Tıp Kurumu Başkanlığı. Haziran-2019;15 [cited 2021 23.01.2021] Available from: https:// www.atud.org.tr/wp-co [in Turkish].
• World Health Organization Global Road Safety Partnership, Speed management: a road safety manual for decision-makers and practitioners, 2008, [cited 2021 23.01.2021] Available from: https://www.who.int/publications/i/item/speedmanagement-a-road-safety-ma.
• du Plessis M, Hlaise KK, Blumenthal R. Ethanol-related death in Ga-Rankuwa road-users, South Africa: A five-year analysis. J Forensic Leg Med. 2016;44:5–9.
• Kim S-C, Lee H-J, Kim J-M, Kong S-Y, Park J-S, Jeon H-J, et al. Comparison of epidemiology and injury profile between vulnerable road users and motor vehicle occupants in road traffic fatalities. Traffic Inj Prev. 2019;20 6 :581–7.
• Aydın B, Biçer Ü, Çolak B, Fincancı ŞK. Position and Traum atic Lesion Localization in Cases o f M otor Vehicle Accidents. Bull Leg Med. 1998 Apr 1;3 1 :20–7.
• Varol O, Eren ŞH, Oğuzyürk H, Korkmaz İ, Beydilli İ. Acil Servise Trafik Kazası Sonucu Başvuran Hastaların İncelenmesi. 2006; 28 2 :55–60 [in Turkish].
• Bouaoun L, Haddak MM, Amoros E. Road crash fatality rates in France: A comparison of road user types, taking account of travel practices. Accid Anal Prev. 2015;75:217–25.
• Beck LF, Dellinger AM, O’Neil ME. Motor Vehicle Crash Injury Rates by Mode of Travel, United States: Using Exposure-Based Methods to Quantify Differences. Am J Epidemiol. 2007 Jul 15;166 2 :212–8.
• Dilim H, Evaluation of the Contribution of Systematic Autopsy on Determining the Cause of Death Among Deaths Due to Road Traffic Accidents, Master Thesis; 2017.
• Reddy NB, Hanumantha, Madithati P, Reddy NN, Reddy CS. An epidemiological study on pattern of thoracoabdominal injuries sustained in fatal road traffic accidents of Bangalore: Autopsy-based study. J Emerg Trauma Shock. 2014 Apr;7 2 :116–20.
• Aydeniz E, Ünaldı M, Eryiğit H, Güneysel Ö. The Retrospective Evaluation of Injuries Owing to Traffic Collisions in Emergency Department. J Kartal TR. 2014;25 1 :5–12.
• Abu-Zidan FM, Eid HO. Factors affecting injury severity of vehicle occupants following road traffic collisions. Injury. 2015 Jan 1;46 1 :136–41.
• Papalimperi AH, Athanaselis SA, Mina AD, Papoutsis II, Spiliopoulou CA, Papadodima SA. Incidence of fatalities of road traffic accidents associated with alcohol consumption and the use of psychoactive drugs: A 7-year survey 2011-2017 . Exp Ther Med. 2019 Sep;18 3 :2299–306.
• McWade CM, McWade MA, Quistberg DA, McNaughton CD, Wang L, Bux Z, et al. Epidemiology and mapping of serious and fatal road traffic injuries in Guyana: results from a cross-sectional study. Inj Prev J Int Soc Child Adolesc Inj Prev. 2017 Oct;23 5 :303–8.
• Zangooei Dovom H, Shafahi Y, Zangooei Dovom M. Fatal accident distribution by age, gender and head injury, and death probability at accident scene in Mashhad, Iran, 2006-2009. Int J Inj Contr Saf Promot. 2013;20 2 :121–33.
• Rowe R, Roman G, Mckenna F, Barker E, Poulter D. Measuring errors and violations on the road: A bifactor modeling approach to the Driver Behavior Questionnaire. Accid Anal Prev. 2015 Jan 31;74.
• Majdan M, Rusnak M, Rehorcikova V, Brazinova A, Leitgeb J, Mauritz W. Epidemiology and patterns of transport-related fatalities in Austria 1980-2012. Traffic Inj Prev. 2015;16 5 :450–5.
• Heinrich D, Holzmann C, Wagner A, Fischer A, Pfeifer R, Graw M, et al. What are the differences in injury patterns of young and elderly traffic accident fatalities considering death on scene and death in hospital? Int J Legal Med. 2017 Jul;131 4 :1023–37.
• Öztürk İ , Özkan T . Genç sürücülerde sürücü becerileri ve sürücü davranışları arasındaki ilişki. Trafik ve Ulaşım Araştırmaları Dergisi. 2018;1 2 :1-15 [in Turkish].
• Solakoğlu Uçar M, Bakırcı N, Harmanı H. İstanbul’daki motosikletli kuryelerde iş kazası niteliğindeki trafik kazaları. Türk Tabipler Birliği Mesleki Sağlık ve Güvenlik Dergisi. OcakŞubat-Mart 2006;48-52 [in Turkish].
• Mitchell RJ, Bambach MR, Toson B. Injury risk for matched front and rear seat car passengers by injury severity and crash type: An exploratory study. Accid Anal Prev. 2015 Sep;82:171–9.
• Vanlaar W, McAteer H, Brown S, Crain J, McFaull S, Hing MM. Injuries related to off-road vehicles in Canada. Accid Anal Prev. 2015 Feb;75:264–71.
• World Health Organization Global Status Report On Alcohol And Health, 2018, [cited 2021 23.01.2021] Available from: https://apps.who.int/iris/bitstream/hand le/10665/274603/9789241565639-eng.pdf?ua=1&ua=1.
• T.C. İçişleri Bakanlığı Emniyet Genel Müdürlüğü Narkotik Suçlarla Mücadele Daire Başkanlığı Türkiye Uyuşturucu Raporu 2019 [cited 2021 23.01.2021] Available from: http://www. narkotik.pol.tr/kurumlar/narkotik.pol.tr/TUBİM/Ulusal%20 Yayınlar/2019-TURKIYE-UYU.
• Shih H-C, Hu S-C, Yang C-C, Ko T-J, Wu J-K, Lee C-H. Alcohol intoxication increases morbidity in drivers involved in motor vehicle accidents. Am J Emerg Med. 2003 Mar;21 2 :91–4.
• Stübig T, Petri M, Zeckey C, Brand S, Müller C, Otte D, et al. Alcohol intoxication in road traffic accidents leads to higher impact speed difference, higher ISS and MAIS, and higher preclinical mortality. Alcohol. 2012 Nov;46 7 :681–6.
• T.C. Sağlık Bakanlığı Sağlık İstatistikleri Yıllığı 2017. [cited 2021 23.01.2021] Available from: https://ohsad.org/ wp-content/uploads/2018/12/28310saglik-istatistikleri-yilligi2017pdf.pdf [in Turkish].
• Santoyo-Castillo D, Pérez-Núñez R, Borges G, Híjar M. Estimating the drink driving attributable fraction of road traffic deaths in Mexico. Addiction. 2018 May;113 5 :828–35.
• Doğan S, Acil Servise Araç İçi Trafik Kazasi Nedeni ile Başvuran Hastalarda Kan Alkol Düzeyi ile Yaralanma Ciddiyetinin İlişkisi, Eskişehir Osmangazi Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalı. Uzmanlık tezi. 2014 [in Turkish].
• Brainard BJ, Slauterbeck J, Benjamin JB, Hagaman RM, Higie S. Injury profiles in pedestrian motor vehicle trauma. Ann Emerg Med. 1989 Aug;18 8 :881–3.
• Arslan MN, Kertmen Ç, Melez DO, Evcüman D, Büyük Y. Use of trauma scoring systems to determine the physician’s responsibility in cases of traumatic death with medical malpractice claim. Ulus travma ve acil cerrahi Derg = Turkish J trauma Emerg Surg TJTES. 2017 Jul;23 4 :328–36.
• Eid HO, Barss P, Adam SH, Torab FC, Lunsjo K, Grivna M, et al. Factors affecting anatomical region of injury, severity, and mortality for road trauma in a high-income developing country: lessons for prevention. Injury. 2009 Jul;40 7 :703–7.
• Lovely R, Trecartin A, Ologun G, Johnston A, Svintozelskiy S, Vermeylen F, et al. Injury Severity Score alone predicts mortality when compared to EMS scene time and transport time for motor vehicle trauma patients who arrive alive to hospital. Traffic Inj Prev. 2018;19 sup2 :S167–8.
• Monchal T, Ndiaye A, Gadegbeku B, Javouhey E, Monneuse O. Abdominopelvic injuries due to road traffic accidents: Characteristics in a registry of 162,695 victims. Traffic Inj Prev. 2018 Mar 6;19:1–17.
• Markogiannakis H, Sanidas E, Messaris E, Koutentakis D, Alpantaki K, Kafetzakis A, et al. Motor vehicle trauma: analysis of injury profiles by road-user category. Emerg Med J. 2006 Jan;23 1 :27–31.
• Durbin DR, Jermakian JS, Kallan MJ, McCartt AT, Arbogast KB, Zonfrillo MR, et al. Rear seat safety: Variation in protection by occupant, crash and vehicle characteristics. Accid Anal Prev. 2015 Jul;80:185–92.
• Smith K, Cummings P. Passenger seating position and the risk of passenger death in traffic crashes: A matched cohort study. Inj Prev. 2006 Apr 1;12:83–6.
• Baldo V, Marcolongo A, Floreani A, Majori S, Cristofolettil M, Dal Zotto A, et al. Epidemiological aspect of traumatic brain injury in Northeast Italy. Eur J Epidemiol. 2003;18 11 :1059– 63.
• Knight B, Saukko P. Knight’s forensic pathology, 4th ed, 2016, Chapter: 9.
• Nirula R, Pintar FA. Identification of vehicle components associated with severe thoracic injury in motor vehicle crashes: a CIREN and NASS analysis. Accid Anal Prev. 2008 Jan;40 1 :137–41.
• Newgard CD, Lewis RJ, Kraus JF. Steering wheel deformity and serious thoracic or abdominal injury among drivers and passengers involved in motor vehicle crashes. Ann Emerg Med. 2005 Jan;45 1 :43–50.
• Hsieh T-M, Tsai T-C, Liu Y-W, Hsieh C-H. How Does the Severity of Injury Vary between Motorcycle and Automobile Accident Victims Who Sustain High-Grade Blunt Hepatic and/or Splenic Injuries? Results of a Retrospective Analysis. Int J Environ Res Public Health. 2016 Jul;13 5 .
• Ndiaye A, Chambost M, Chiron M. The fatal injuries of car drivers. Forensic Sci Int. 2009 Jan;184 1–3 :21–7.
• Daskal Y, Alfici R, Givon A, Peleg K, Olsha O, Kessel B. Evaluation of differences in injury patterns according to seat position in trauma victims survived traffic accidents. Chinese J Traumatol = Zhonghua chuang shang za zhi. 2018 Oct;21 5 :273– 6.
• Bansal V, Conroy C, Tominaga GT, Coimbra R. The utility of seat belt signs to predict intra-abdominal injury following motor vehicle crashes. Traffic Inj Prev. 2009 Dec;10 6 :567–72.
• Di Maio V, Di Maio D. Forensic Pathology Second Edition, 2001, Chapter 9.
• Burkhart HM, Gomez GA, Jacobson LE, Pless JE, Broadie TA. Fatal blunt aortic injuries: a review of 242 autopsy cases. J Trauma. 2001 Jan;50 1 :113–5.
• Newman RJ, Rastogi S. Rupture of the thoracic aorta and its relationship to road traffic accident characteristics. Injury. 1984 Mar;15 5 :296–9.
• Conroy C, Schwartz A, Hoyt DB, Brent Eastman A, Pacyna S, Holbrook TL, et al. Upper extremity fracture patterns following motor vehicle crashes differ for drivers and passengers. Injury. 2007 Mar;38 3 :350–7.
• Mizuno K, Matsui Y, Ikari T, Toritsuka T. Seatbelt effectiveness for rear seat occupants in full and offset frontal crash tests. Int J Crashworthiness. 2011 Feb 1;16:63–74.
• Duran E, Ordu O, Tekeş B. İstanbul Şile’de sürücü ve yolcuların emniyet kemeri kullanımı: gözlem çalışması. Trafik ve Ulaşım Araştırmaları Dergisi. 2018;1 2 :16–32 [in Turkish].
• Bilgiç Ş, Vitosoglu Y, Yaliniz P. Kütaha’da emniyet kemeri kullanımı alışkanlıklarının değerlendirilmesi. J Sci Technol Dumlupınar Univ. 2015 Jun 1;34:57-68 [in Turkish].
• Bohman K, Rosén E, Sunnevang C, Boström O. Rear seat occupant thorax protection in near side impacts. Ann Adv Automot Med Assoc Adv Automot Med Annu Sci Conf. 2009 Oct;53:3–12.
• Inaba K, Sharkey PW, Stephen DJG, Redelmeier DA, Brenneman FD. The increasing incidence of severe pelvic injury in motor vehicle collisions. Injury. 2004 Aug;35 8 :759–65.
• Değirmenci B, Akar T, Demirel B. Evaluation of Mortal Traffic Accidents in Terms of Forensic Medicine. GMJ. 2015;26:143-147. 2015 Jan 1;26:143–7.
• Shepherd R. Simpson’s Forensic Medicine, 12th Edition, 2003, Chapter: 12.
• Wyatt JP, O’Donnell J, Beard D, Busuttil A. Injury analyses of fatal motorcycle collisions in south-east Scotland. Forensic Sci Int. 1999 Oct;104 2–3 :127–32.
• Bendak S. Seat belt utilization in Saudi Arabia and its impact on road accident injuries. Accid Anal Prev. 2005;37 2 :367– 71.
• Albertsson P, Falkmer T. Is there a pattern in European bus and coach incidents? A literature analysis with special focus on injury causation and injury mechanisms. Accid Anal Prev. 2005 Mar;37 2 :225–33.
• Grime G, Hutchinson TP. Vehicle mass and driver injury. Ergonomics. 1979 Jan;22 1 :93–104.
• Eluru N, Paleti R, Pendyala R, Bhat C. Modeling Injury Severity of Multiple Occupants of Vehicles Copula-Based Multivariate Approach. Transp Res Rec J Transp Res Board. 2010 Dec 1;2165:1–11.
• Di Maio VJ, Dana SE. Handbook of Forensic Pathology, Department of Pathology University of Texas Health Science Center San Antonio, Texas,1998, Chapter: 14.
• Ballesteros M, Dischinger P, Langenberg P. Pedestrian injuries and vehicle type in Maryland, 1995-1999. Accid Anal Prev. 2004 Feb 1;36:73–81.
• Paulozzi LJ. United States pedestrian fatality rates by vehicle type. Inj Prev J Int Soc Child Adolesc Inj Prev. 2005 Aug;11 4 :232–6.