Road Traffic Accident among Patients Presenting to the Emergency Department of a Tertiary Care Centre: A Descriptive Cross-sectional Study

ABSTRACT Introduction: Road traffic accidents are a public health problem and have emerged as the leading cause of mortality and morbidity. Head is the most commonly affected site of road traffic accidents. The aim of this study was to find out the prevalence of road traffic accidents among patients presenting to the emergency department of a tertiary care centre. Methods: A descriptive cross-sectional study was conducted at the Emergency Department from 12 January 2022 to 14 June 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: COMSTH-IRC/2021-171). Data was collected using a self-structure questionnaire and from emergency tickets. A convenience sampling method was used. Point prevalence and 95% Confidence Interval were calculated. Results: Among 7654 patients, the prevalence of road traffic accidents was found to be 734 (9.58%) (8.49-10.66, 95% Confidence Interval). Most of the accidents took place on Friday 139 (18.94%). The majority of them were soft tissue injuries 279 (38.01%). Conclusions: The prevalence of road traffic accidents was found to be higher compared to similar studies done in similar settings. Accident preventive strategies should be focused on and implemented by all the stakeholders.


INTRODUCTION
Road traffic accidents (RTA) account for a significant proportion of unintentional injuries. 1 In the past two decades, countries have seen significant growth in urbanisation, motorization, industrialization, and changes in the socioeconomic level of the societies. 2 Also, RTA has increased and it has now become a major cause of disability and death globally. 3 Road injuries due to road traffic accidents are a major public health problem in most developing and developed countries. RTAs are increasing day by day leading to injuries, disabilities and deaths. 4 The most common risk factors associated with RTA are over speed, driving under influence, not using safety measures such as seat belts, helmets, and child restraints, poorly constructed roads, increased number of vehicles that are poorly maintained, unplanned urbanization and industrialization, motorization, overpopulation and fragile traffic rules. 5,6 The aim of this study was to find out the prevalence of road traffic accidents among patients presenting to the emergency department of a tertiary care centre.

METHODS
This descriptive cross-sectional study was conducted at the Emergency Department of the College of Medical Sciences and Teaching Hospital from 12 January 2022 to 14 June 2022. Ethical approval was taken from the Institutional Review Committee (Reference number: COMSTH-IRC/2021-171). All the patients who had given consent for data collection with road traffic accidents were included in this study. Patients were selected by using a convenience sampling method. The sample size was calculated using the following formula: The minimum sample size calculated was 601. However, the final sample size taken was 734.
Data were collected using a self-structure questionnaire and from emergency tickets. Sociodemographic data were recorded from emergency tickets while other information was asked of patients/visitors. A systematic medical examination was done and recorded in the questionnaire using a pre-designed questionnaire and then collected data were checked for completeness and accuracy.
Data collected were entered and analysed using IBM SPSS Statistics version 20. Point estimate and 95% CI were calculated.

DISCUSSION
The prevalence of road traffic accident was found to be 9.58% which was higher compared to other studies conducted in Eastern part of Nepal where the prevalence of RTA was reported to be 4% whereas the study conducted in India reported the prevalence to be 41.4%. 7,8 In a similar study, the prevalence of RTA was reported to be 33.2% with 77% male. 9 In our study also, the majority of the RTA victims were male (62.13%) and between 20-30 years (41.96%). A similar study conducted in India showed that 75% of the patients were less than 40 years. 10 In a similar study it was reported that (98.90%) were males and (52.50%) of cases were belonging to the age group of 21-30 years. 11 This may be due to the involvement of male in their outdoor work or their involvement in violent activities as compared to female. Furthermore, the majority of victims were educated up to a Higher secondary level (25.07%) followed by bachelor and above (20.98%). Similarly, one study from India showed that the majority of the cases (39.3%) were graduates, followed by (31.1%) with intermediate education and (11.5%) were illiterate. 11 Majority of the victims were students (32.97%) followed by agricultural workers (23.98%). Similar findings were seen in a study conducted in the Eastern part of Nepal. 7 Similarly, the majority of them were married (61.04%) and belonged to a joint family (85.01%). Similar findings were seen in a study done in the western part of Nepal. 12 The distribution of weekdays shows a denser cluster of accidents on Friday (18.94%) and Saturday (17.03%), which are weekends in Nepal. It could be the higher proportion of the people's movement for marketing and outing on weekends. Another study also reported that weekends were the most common time for accidents. 13 In our study it was found that the majority of RTA took place in the daytime from 12-6 PM. Similar trends were also observed in other studies conducted in various parts of Nepal and India. 14 These hours are the busiest as commuters go to and return from the schools, offices, factories and business places. It could also be due to stress and fatigued drivers because of continuous work and visibility which was reported in studies done in China and Croatia. 15 Majority (64.99%) of accidents were in the highway areas. In a similar study done in Nepal, similar findings were seen. 16 Nearly half of the respondents thus stated that the mechanism of the incident was due to the collision of vehicles (47.96%) and it was mostly fourwheelers (5.99%). The findings reported were different from another study in Nepal and various parts of India. 17 Majority of the RTA was due to personal causes (43.05%). A similar finding was also seen in study. 17 Considering all the cases of injuries, the majority was soft-tissue injury (38.01%) followed by head injuries (31%) and nearly half of the patients were referred to the General ward (41.01%) followed by discharge (38.69%). In a similar study conducted in Nepal, the most common time duration of occurrence of RTA was reported to be 6-12 PM (62%), most common injury after RTA was head injury 64%. 7 These similar findings were seen in a study conducted at Karnali. 19 Among all the injured patients, 3.80% were dead. Mortality among RTA cases was found to be 3.15%. 7 In another study, similar findings were seen. 18 The present study was a descriptive cross-sectional study conducted in a single centre, the result may not be generalised to other settings of Nepal. Data was collected from the patient's side which might have information and response bias.

CONCLUSIONS
The prevalence of road traffic accidents was found to be higher compared to similar studies done in similar settings. Young adult males with higher secondary education become more victims of road traffic accidents. Soft tissue injuries and head injuries were the commonest sites of injury in these areas. This shows that understanding such factors are crucial in developing and implementing accident prevention strategies in present scenarios.