Sudskomedicinske karakteristike povreda i mehanizmi povređivanja smrtno stradalih učesnika u saobraćajnim nezgodama

Abstract

Uvod: Saobraćajne nezgode predstavljaju veliki zdravstveni problem na globalnom nivou čije su najteže posledice povrede, invaliditeti i smrtni ishod učesnika. Cilj: Analiza vulnerabilnosti i trenda različitih smrtno stradalih učesnika saobraćajnih nezgoda, objasniti mehanizam nastanka povreda i uzroka smrti. Materijal i metode: Urađena je retrospektivna, autopsijska studija preseka na materijalu Službe za sudsku medicinu i toksikologiju KC Kragujevac. U studiju su uključeni svi učesnici saobraćajnih nezgoda koji su umrli od zadobijenih povreda ili njihovih komplikacija u periodu od 2001. do 2016. godine. Rezultati: Studija je obuhvatala 525 učesnika čija je smrt posledica saobraćajne nezgode, odnosno 38% od ukupno obdukovanih. Muškaraca je bilo više nego žena. Prosečna starost učesnika je bila 52±19godina, pri čemu su žene bile starije od muškaraca. Najvulnerabilniji učesnici su bili pešaci (42%), vozači motornih vozila (19%) i suvozači (15%). Najčešće povređeni deo tela bio je grudni koš (78%), zatim glava (65%), a najmanje su bile prisutne povrede trbuha (38%). Povreda glave se izdvaja kao najčešći uzrok smrti, bilo singularan ili u kombinaciji sa drugim uzrocima, kao što su iskrvarenje i poremećaj disanja. Nešto više od polovine učesnika (55%) je stradalo na licu mesta saobraćajne nezgode ili na putu do odgovarajuće zdravstvene ustanove, dok je 45% učesnika nadživljavalo povrede određeni vremenski period. Pešaci i biciklisti češće nadživljavaju povrede, a vozači češće stradaju na licu mesta, što je statistički značajno. Učesnici saobraćajnih nezgoda umrli na licu mesta imaju 12 puta veći rizik za predvajanje moždanog stabla, oko 6 puta veći rizik za destrukciju kostiju lobanje ili razorenje mozga i oko 3 puta veći rizik za povredu vratne kičme. Kod učesnika umrlih na licu mesta više od 8 puta je veći rizik za nastanak rupture aorte, a oko 5 puta veći za razvoj pneumotoraksa i hemotoraksa. Oko 8 puta je veći rizik za nastanak rascepa slezine i oko 3 puta veći rizik za prisustvo rascepa ili razorenja jetre. Pozitivna alkoholemija je dokazana kod 33% testiranih smrtno stradalih učesnika saobraćajnih nezgoda, a srednja vrednost alkoholemije je bila 1,4±0,9‰. Alkoholisanih muškaraca je bilo više nega žena, sa značajno većom srednjom vrednošću alkoholemije. Svaki treći vozač putničkog motornog vozila ili vozač motocikla bio je u alkoholisanom stanju. Zaključak: Najzastupljeniji smrtno stradali učesnici saobraćajnih nezgoda su pešaci, muškog pola, prosečne starosti oko 60 godina sa povredama grudnog koša od kojih nakon povređivanja umiru na licu mesta.

Introduction: Road traffic accidents represent a great health problem on the global scale with the hardest consequences being injuries, invalidity and deathly outcomes of the subjects. Aim: The aim of this study was to analyze the vulnerability and the trends in the fatalities of road traffic accidents subjects, and to explain the mechanisms of injuries’ occurrences and causes of death. Materials and methods: The retrospective autopsy cross-sectional study was performed on the materials from the Clinical Centre of Kragujevac, Department of Forensic Medicine and Toxicology. The study included all of the participants in road traffic accidents who died from the sustained injuries or due to their complications during the period from 2001 to 2016. Results: The study included 525 subjects who died due to the consequences of traffic accidents, i.e. 38 % of the total number of the autopsy cases. There were more men than women. The average age of the subjects was 52±19 years, with women being older than men. The most vulnerable subjects were pedestrians (42%), motor vehicle drivers (19%) and front-seat passengers (15%). The chest injuries were the most frequent (78%), then the head injuries (65%) and finally abdominal injuries (38%). The head injury was the most frequent cause of death, on its own or in a combination with the other causes, such as the exsanguination or the breathing disorders. More than half of the subjects (55 %) died at the scene of the accident or on their way to the hospital, while 45 % of them outlived the injuries for a certain period of time. The pedestrians and the bicyclists outlived their injuries more frequently, while drivers died more frequently at the scene, which is statistically significant. The road traffic accidents’ subjects who died at the scene were at 12 times higher risk of getting split brainstem, around 6 times higher risk for skull bones or brain destruction and around 3 times for cervical spine injury. There was also 8 times greater risk of aortic rupture, and around 5 times for the development of pneumothorax and haemothorax. Furthermore, there was around 8 times higher risk of the spleen rupture and around 3 times for the liver rupture or its complete destruction. The positive blood alcohol level was found in 33% of the tested deceased subjects, and the arithmetic value of the blood alcohol level was 1.4±0.9‰. Men were more intoxicated than women, with a significantly higher arithmetic value. Every third motor vehicle driver or motorcyclist was intoxicated. Conclusion: The majority of fatalities in road traffic accidents are male pedestrians, average age being 60, with chest injuries and deathly outcome at the scene.