Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 10  |  Issue : 6  |  Page : 568-572  

Physical injury: Is it inevitable or preventable? an experience from a Tertiary Care Hospital of Kolkata, West Bengal


1 Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
2 Department of Community Medicine, Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India

Date of Submission17-Apr-2017
Date of Acceptance07-Jun-2017
Date of Web Publication17-Jan-2018

Correspondence Address:
Dr. Bobby Paul
P-19, Jadavpur University Employees’ Housing Co-operative Society Ltd., P. O. Panchasayar, Kolkata - 700 094, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_81_17

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  Abstract 


Introduction: Injuries are not random events – they have identifiable precipitating factors, and are therefore among public health's winnable battles. Substantial data-based study can help identify measures to prevent the occurrence of physical injury. Our objective was to find out the injury profile of patients attending a tertiary care hospital and assess their perception toward preventability of the event in light of their causation. Materials and Methods: This cross-sectional study was conducted on patients attending selected Outpatient and Inpatient Departments of Institute of Postgraduate Medical Education and Research, Kolkata, from February to March 2014. 216 patients who had suffered any form of physical injury and admitted/attending the selected departments were included in the study by complete enumeration method, after exclusion of unwilling and severely moribund patients. Pearson's Chi-square test was performed using Epi Info software version 3.2. Results: Highest proportion of physical injuries (24.07%) occurred among 30–40 years age group. Road traffic accidents (RTAs) were the most common type of injury (38.8%) followed by falls (34.7%). 38.6% of the falls occurred inside victim's homes and 25.3% occurred on road. Electricity caused 55.1% burn injuries. Faulty driving attributed to 47% of the RTAs as perceived by its victims. Majority of the victims (60.2%) opined that their injuries were not preventable. Conclusion: Raising public awareness that injury is preventable to a great extent, would help in averting such incidents, and thereby reduce unnecessary injury-related morbidity and mortality.

Keywords: Inevitable, physical injury, preventable, road traffic accident


How to cite this article:
Paul B, Sinha D, Misra R, Basu M, Ray S. Physical injury: Is it inevitable or preventable? an experience from a Tertiary Care Hospital of Kolkata, West Bengal. Med J DY Patil Univ 2017;10:568-72

How to cite this URL:
Paul B, Sinha D, Misra R, Basu M, Ray S. Physical injury: Is it inevitable or preventable? an experience from a Tertiary Care Hospital of Kolkata, West Bengal. Med J DY Patil Univ [serial online] 2017 [cited 2019 Nov 19];10:568-72. Available from: http://www.mjdrdypu.org/text.asp?2017/10/6/568/223372




  Introduction Top


An injury is “the physical damage that results when a human body is suddenly subjected to energy in amounts that exceed the threshold of physiological tolerance – or else the result of a lack of one or more vital elements, such as oxygen.”[1] Injuries can be classified on the basis of medicolegal importance (e.g., intentional, accidental, or undetermined intent), or on the basis of modality (e.g., traumatic, thermal, falls, drowning, poisoning, and injury from animals).[1]

Injuries account for 9% of global mortality and 27% of all deaths among children aged 5–14 years.[2] According to the WHO (2014), more than 5 million people die each year as a result of injuries and the quantum is nearly 1.7 times the number of fatalities that result from HIV/AIDS, tuberculosis, and malaria combined.[3]

Road traffic injuries are leading cause of death among productive age group (15–29 years)-1.24 million worldwide and 161,736 people in India (2010). Next comes falls followed by drowning. Burns are the most common cause of domestic injury with greater proportion among women; 24,414 people had been victims of burn injury in India in 2010.[4]

Poisoning is the most common form of suicidal injury in rural areas. Fatality is 95,000 deaths in Southeast Asian countries with India accounting for 28,012 deaths, whereas, industrial injuries are common form of injury in urban areas.[5] According to the “injury pyramid,” millions of death resulting from injuries represents only a small fraction of those injured.[6]

The various forms of physical injury lead to huge loss of countries' resources and DALY; thus it is very much pertinent to prevent such loss by preventing the occurrence of unintentional and intentional injury and spread awareness that “Accidents are preventable.”

Substantial data based study can not only help in identifying key risk factors that cause injuries but can also help recommend health facilities necessary measures required to cater to needs of injured patients which would further minimize the disability and ill-health arising from the events that do occur. With this background, the present study was undertaken to find out the profile of patients with physical injuries attending a tertiary care hospital of Kolkata and to assess their perception toward preventability of the event that had caused their injury.


  Materials and Methods Top


An institution-based, observational, descriptive study with cross-sectional design was conducted from February to March 2014. The study population comprised all the physical injury victims reporting to selected Outpatient Departments (OPDs) and admitted to selected Inpatient Departments (IPDs) of Institute of Postgraduate Medical Education and Research (IPGME and R), Kolkata in the above-mentioned period. It is the only super specialized government institute of the state of West Bengal. Patients of all ages and both sexes with physical injuries comprised our study population. All the consecutive patients with physical injuries who had attended the selected OPDs or were admitted in the selected IPDs of that hospital during data collection period were included in the study by complete enumeration method, which came out to be 216. Severely ill and moribund patients were excluded from the study. Information was noted down on a predesigned and pretested structured schedule (prepared in consultation with three experts of community medicine, pretested on 50 injury patients of the same hospital other than the ones selected for the study, modified and validated by another three experienced persons of community medicine). The study technique was face-to-face interview and record review of the relevant documents and reports. The schedule had two parts. Part I comprised information on the sociodemographic status, that is, age, gender, religion, residence, marital status, education, occupation, addiction, and per capita monthly income (PCMI). Part II comprised injury profiles (cause, timing, place, site of injury, place of initial treatment, disability suffered after injury, risk factors, and cause of visit to this hospital). The different attributes and study variables were age, gender, religion, residence, marital status, education, occupation, addiction, PCMI, cause of injury, timing of injury, place of injury, site of injury in body, place of initial treatment, disability suffered after injury, risk factors leading to injury, and cause of visit to this hospital.

Ethical clearance was obtained from the Institutional Ethics Committee of the hospital, and participants were recruited only after getting informed written consent from the patients. The participation was voluntary, not compulsory, and they were assured about confidentiality and anonymity.

Operational definitions

Type of injury sustained

  1. Road traffic accident (RTA) - Injury sustained by collision with vehicle, collision between vehicles, fall from vehicle, overturning, or fall of vehicle from height (in case of bridge/hills), etc.
  2. Physical assault - Intentional physical attack by any person or group of persons
  3. Poisoning - Ingestion or contact with poison
  4. Falls - Fall on ground from height, after stumbling, etc.
  5. Burn Injury - Burn due to fire or electrocution
  6. Hanging - Complete or partial suspension.


Statistical analysis

The data were scrutinized for completeness and all records were checked twice. Finally, the collected data were entered in Microsoft Excel. The analysis was done in Microsoft Excel 2010 (Microsoft Corp, Redmond, WA, USA). Association between two attributes was checked by Pearson's Chi-square (c2) test statistic. Calculation was done in Epi-info Software Version 3.2 (Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia (USA)).


  Results Top


A total of 216 physical injury patients participated in the study. Out of them, 43.5% injury occurred among people of 20–40 years of age. People belonging to extremes of age groups, that is, 0–10 years and 70–80 years suffered least from of injury (6.48% and 4.16%, respectively); males suffered more (76.85%) than females (23.15%); majority of injury victims were Hindus (65.23%), followed by Muslims (33.33%), and Christians (1.44%); 60.18% of injury occurred to rural residents as compared to urban residents (39.82%); about 22.6% injury victims belonged to Kolkata district; and 6.48% of the sufferers were from areas outside the state of West Bengal, namely, Bihar, Jharkhand, Assam, etc. So far, the educational status concerned, 19.9% of the victims were illiterate. Regarding occupation, more unskilled laborers (39.36%) had suffered from injury as compared to only 12.96% homemakers and 15.74% students. With regards to socioeconomic status, 34.26% of the study population belonged to upper-lower income group as per modified BG Prasad socioeconomic status scale 2013. About 81.4% did not have any preexisting disease and preexisting disability was absent in 93.9% cases; 42.59% had addiction; of which 43.47% had tobacco addiction followed by addiction to alcohol (29.35%).

RTAs were the most common cause of injury (38.9%) followed by falls (34.7%). Accidental injuries (93.5%) occurred more often than intentional/homicidal (4.7%) or suicidal (1.8%) injuries. Most of the injuries occurred to the victim when he/she was on road (45.3%), whereas minimum number of injuries occurred to the victim on agricultural field (0.9%). Lower limb was maximally (54.1%) injured followed by upper limb (43%). RTAs and railway accidents made nearly all its victims disabled (100%), whereas physical assaults caused least disability (37.5%). More than half injuries occurred in the morning; most of the falls (48%) occurred in the morning, burn injuries (51.7%) and RTAs (35.7%) in the evening, assaults (25%) in the afternoon as well as evening, and rail accidents (47%) occurred mainly at night [Table 1].
Table 1: Distribution of the study participants according to injury profile (n=216)

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After injury, most of the victims were initially treated in government hospitals (62.5%) whereas only a few victims (5%) underwent first aid at home. Maximum number of injury victims (59.7%) came to this tertiary care hospital on referral from other places. Most of the RTAs (47%) occurred due to faulty driving as perceived by the victims of RTA whereas bad weather was responsible in only a few cases (3.6%). Majority of the injuries due to fall occurred at home (38.6%), followed by road (25.3%) and staircase (10.7%). Majority of the burn injury was due to electrocution (55.1%), followed by kitchen source/stove (20.7%) [Table 2].
Table 2: Treatment profile and modality of road traffic accident, fall, and burn injury

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Majority of the RTA cases (36.9%) occurred in evening, followed by night (26.2%); whereas almost half of the non-RTA cases occurred in the morning time. This association was found to be statistically significant (c2 = 19.65, P < 0.05). Regarding cause and timing of injury, most of the accidental and nonaccidental injury happened in the morning, followed by evening (30.2%) in accidental and both evening and afternoon in others cases, but without any statistical significance (P = 0.79) [Table 3].
Table 3: Association between type and cause of injury with timing of injury (n=216)

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Almost in every instance, majority of the respondents opined that the injury was inevitable, excepting in case of fall injury where majority of the respondents told that the injury was preventable. This association was found to be statistically significant by Pearson's Chi-square test (P< 0.05) [Table 4].
Table 4: Distribution of the participants according to injury types and their perception

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  Discussion Top


Physical injury which was the primary outcome measure of this study was found to be mostly due to RTAs followed by falls and burns. On exploring the secondary outcome measure, that is, perception of patients, whether the injury sustained was inevitable or avoidable, it was found that except fall injury victims, majority of the injured thought that the event causing their injury was inevitable.

The present cross-sectional study carried out in a tertiary hospital of Kolkata revealed that most of the injuries occurred in the age group of 20–40 years of population which is the most active and productive age group resulting in huge productive person-days lost and causing serious economic loss to the community. Earlier studies have also reported a higher proportion of injuries in similar age groups.[7],[8],[9],[10] This higher proportion of injuries in these age groups may be attributed to the risk-taking behavior of youth population.

In this study male: female ratio was 3.5:1 which can be attributed to the fact that in India males are still the bread earners for the family and therefore involved usually in outdoor activities exposing themselves to work-related stress and injuries. Male predominance was also observed by Ganveer and Tiwari, Jha et al., Swarnkar et al., Dsouza et al., Ray et al., and Verma in their studies in India.[7],[8],[9],[10],[11],[12]

Similar to present study, Swarnkar et al. also found RTA as the most common type of injury followed by falls.[9] Ahmad and Karmakar from a tertiary care hospital in Kolkata also reported RTA as the most common cause of head injury (85.95%), and males aged 21–30 years and business by occupation were more involved.[13] In contrary to the present findings, Ray et al. in Siliguri,[11] Verma in Delhi,[12] and Dsouza et al. in Karnataka [10] documented falls as most common type of overall injuries followed by RTA. Shrestha et al. from Kathmandu also reported that fall from height was the most common mode of injury followed by RTAs among the patients coming to the hospital while significant number of trauma patients coming to outreach centers had suffered injuries due to fall from height.[14] However, Hokkam et al. in Saudi Arabia found that the most common kind of injury was minor injury (60%), followed by blunt trauma (30.9%) and then penetrating trauma (9.1%).[15]

This discrepancy in predominant cause of injury across the globe may be related to geographical distribution and related sociodemographic factors of the study settings.

Unintentional injury emerged as one of the major reason behind injury causation in the present study; similar to the findings of Ray et al.[11] and Swarnkar et al.[9]

Our study revealed that major cause of burn injury was electrocution (55.1%), followed by kitchen source/stove (20.7%) which is in contrast to a study reported from Ghana by P. Agbenorku et al., comprising 263 (54.0%) male and 224 (46.0%) female burn injury patients, where it was found that children 0–10 years were the most affected age group and the majority of burns was caused by scalding.[16]

When temporal distribution of the injuries was studied, it was observed that in this study almost half of the injuries took place in the daytime. This can be because of the increased activities on road during daytime such as commercial activities, activities such as attending the schools, colleges, and offices. This increases the probability of the accidents in the daytime. Similar finding has also been noted by Ganveer and Tiwari [7] However, Verma in Karnataka found that majority of cases were admitted in night time.[12]

Similar to the findings of Ganveer and Tiwari Jha et al., Verma, Dsouza et al., and Ray et al., the present study also found lower extremity as the most common site of body injury.[7],[8],[9],[10],[11] More than two-third of the patients experienced injuries at road, which was also documented by Swarnkar et al.[9] However, Ray et al. in their study found that most of the injuries occurred at home.[11] It was revealed that 62.5% of patients took treatment from government hospitals, which was not in accordance with the study by Ray et al., where most of the injuries were managed by first-aid care outside government hospitals.[11]

The strength of the study was that it was conducted in the one and only super specialty government hospital of West Bengal with state of the art trauma care facilities, thus making it an important referral center for physical injury victims. The study had limited external generalizability as it was a hospital-based study with no sampling design and hence temporal association could not be established.


  Conclusion Top


The mortality and economic losses imposed by physical injuries are largely preventable. Raising public awareness that injuries are not inevitable and that they have specific modality of causation and hence can be prevented to a great extent would help to reduce the unnecessary loss of life that occurs each day as a result of injury. Community preparedness for injury prevention by designing intervention strategies to promote safety education, road safety measures, personal protection, machine safety, legislative measures, etc., would help to alleviate injury proneness of individuals, thereby making the physical injury a preventable event.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Holder Y, Peden M, Krug E, Lund J, Gururaj G, Kobusingye O. Injury surveillance guidelines. Geneva: World Health Organization; 2001.  Back to cited text no. 1
    
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Improving the Quality and use of Birth, Death and Cause-of-Death Information: Guidance for a Standards-Based Review of Country Practices. Geneva: World Health Organization; 2010.  Back to cited text no. 2
    
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Injuries and Violence: The Facts 2014. World Health Organization; 2014. p. 2-3. Available from: http://www.who.int/violence_injury_prevention/media/news/2015/Injury_violence_facts_2014/en/. [Last accessed on 2016 Dec 14].  Back to cited text no. 3
    
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Cause of Death 2008 Summary Tables. Geneva: Global Health Observatory Data Repository, World Health Organization; 2011. Available from: http://www.apps.who.int/ghodata/. [Last accessed on 2016 May 18].  Back to cited text no. 4
    
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World Health Organization. Injuries and Violence: The Facts. Injury Pyramid. Geneva: World Health Organization; 2010. p. 8.  Back to cited text no. 6
    
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Ganveer GB, Tiwari RR. Injury pattern among non-fatal road traffic accident cases: A cross-sectional study in Central India. Indian J Med Sci 2005;59:9-12.  Back to cited text no. 7
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8.
Jha N, Srinivasa DK, Roy G, Jagdish S. Injury pattern among road traffic accident cases: A study from South India. Indian J Community Med 2003;28:85-9.  Back to cited text no. 8
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Swarnkar M, Singh P, Dwivedi S. Pattern of trauma in central India: An epidemiological study with special reference to mode of injury. Int J Epidemiol 2009;9:DOI: 10.5580/6a3.  Back to cited text no. 9
    
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Dsouza C, Rao VV, Kumar A, Diaz E. Epidemiological trends of trauma in tertiary care centre in Dakshina Kannada district of Karnataka, India. J Clin Diagn Res 2014;8:66-8.  Back to cited text no. 10
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Ray K, Bhattacherjee S, Akbar F, Biswas R, Banerjee R, Chakraborty M. Physical injury: A profile among the municipal primary school children of Siliguri, Darjeeling District. Indian J Public Health 2012;56:49-52.  Back to cited text no. 11
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Verma PK. Community based epidemiological study of injury in India. Inj Prev 2012;18:A243.  Back to cited text no. 12
    
13.
Ahmad Z, Karmakar RN. An epidemiological study of acute head injury and its evaluation by CT scan. J Indian Acad Forensic Med 2014;36:173-5.  Back to cited text no. 13
    
14.
Shrestha R, Shrestha SK, Kayastha SR, Parajuli N, Dhoju D, Shrestha D. A comparative study on epidemiology, spectrum and outcome analysis of physical trauma cases presenting to emergency department of Dhulikhel Hospital, Kathmandu University Hospital and its outreach centers in rural area. Kathmandu Univ Med J (KUMJ) 2013;11:241-6.  Back to cited text no. 14
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Hokkam E, Gonna A, Zakaria O, El-Shemally A. Trauma patterns in patients attending the Emergency Department of Jazan General Hospital, Saudi Arabia. World J Emerg Med 2015;6:48-53.  Back to cited text no. 15
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Agbenorku P, Aboah K, Akpaloo J, Amankwa R, Farhat B, Turkson E, et al. Epidemiological studies of burn patients in a burn center in Ghana: Any clues for prevention? Burns Trauma 2016;4:21.  Back to cited text no. 16
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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