1. "Unintentional Injury”
A descriptive analysis of 8,092
Emergency admissions
Dr. Srihari Cattamanchi
Post Graduate Resident
M.D. Accident & Emergency Medicine

2. Leading Causes of Death World Wide

3. 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.

4. 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.

5. Methods (Cont..)
• Sampling technique: Consecutive sampling.
• Sample Size: 8,092 patients.
• Instrument: Pre-formatted Questionnaire.

7. 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.

8. Methodology
Inclusion criteria:
All patients registered with injury to
emergency due to Unintentional Intent.
Exclusion criteria:
a. Old Injuries
b. Burns

9. RESULTS - Patient profile
740
723
728
702
769
745
740
759
790
728
720
723
2628
2419
2420
2181
2097
1848
2235
2424
2810
2595
2248
2252
0 1000 2000 3000 4000
August
September
October
November
December
January
February
March
April
May
June
July
No of Patients
MonthsAugust2006-July2007
Injury 8,823 Other Illness 28,156
N = 36,979
24.3%
21.2%
21.9%
23.8%
24.8%v
28.7%
26.8%
24.3%
22.7%
23%
21.1%
24.2%

10. Intent of Injury
n = 8,823
8092
669
62
Unintentional 91.7%
Suicidal 7.3%
Homicidal 1%

11. Injury - Frequency, Percentage & Crude Rates
Cause of
Death
Frequency Percentage
Rate per 10,000
population
Unintentional 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

12. Aetiology of Injury
0 1000 2000 3000 4000 5000
Road traffic Accidents
Falls
Industrial Accidents
Poison
Assault
Others
Hanging n = 8,823
0.6%
2%
6.7%
22%
54%
1.7%
13%

13. Weekly distribution of Injury
16%
13%
12%
14%
14%
16%
15%
Sunday 1430
Monday 1170
Tuesday 1091
Wednesday 1258
Thursday 1182
Friday 1364
Saturday 1328
n = 8,823

14. Injury – Triage priority
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Priority 1 Priority 2 Priority 3
Injuries
Female
Male
n = 8,823
Priority 1: Life - threatening
Priority 2: Potential Life - threatening
Priority 3: Non – Life - threatening
8%
44% 48%

15. Injury - Age and Gender Distribution
0
200
400
600
800
1000
1200
1400
1600
1800
0-9
10-19
years
20-29
30-39
40-49
50-59
60-69
70-79
>80
Injuries
Age
Female
Male
n = 8,823

16. 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

17. Activity during Injury
3996
1551
1391
794
531
Travelling 49%
Walking 19%
Working 17%
Playing 9%
Others 6%
n = 8,823

18. Road Traffic Accidents

19. RTA - Age and Gender
0
200
400
600
800
1000
1200
0 - 9 10 - 19
years
20 - 2930 - 3940 - 4950 - 5960 - 6970 - 79 > 80
Injuries
Female
Male
n = 4406

20. RTA – Mechanism of Injury
0
200
400
600
800
1000
1200
1400
1600
1800
2000
Skid and
Fall
Motor
Vehicle
Collision
Pedestrian Bicycle
1882
1686
691
221
Injuries
n = 4406
42%
38%
15%
5%

21. RTA - Victim profile
0
500
1000
1500
2000
2500
Rider Driver Passenger Pedestrian Cyclist
Male
Female
56%
20%
26%
16%
4%
n = 4406

22. RTA – Vehicle Involved
0
500
1000
1500
2000
2500
3000
Female
Male
57%
23%
16%
5%
9%
n = 4406

23. Injuries due to Fall

24. Profile of Injuries due to fall
0
200
400
600
800
1000
1200
Slip and
Fall
Fall from
Height < 1
meter
Fall from
Height > 1
meter
Fall from
Stairs
Female 118
Male 288
59%
12%
6%
n = 1799
23%

25. Injury due to Fall - Gender and Age
0
50
100
150
200
250
300
350
0 - 9 10 - 19
years
20 - 2930 - 3940 - 4950 - 5960 - 6970 - 79 80
Female
Male
n = 1799

26. • Pre Event
Sign Boards (wet floor, Under Repair, Men at Work)
Drunken Driving
Traffic Rules
• Event
Seat Belts & Helmets
Safety Measures & Gears at Work
• Post Event
First Aid
Proper Immobilization & Transport
Pre-Hospital Care
• Community Education
Unintentional Injuries – Areas of Intervention
Haddon’s Phases of Prevention

27. 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.

28. • 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..)

29. Disposition after Initial Treatment
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Discharged
4587
Admitted
2735
DAMA 1389 Expired 112
n = 8,092
31%
52%
12%
1.28%

30. Injury Pyramid
n = 8,092
1
Death
24
Hospitalised
41
Treated and Discharged

31. 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.

32. • 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

33. 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.

34. Prevent injury
for
Better Health
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