Analysis of Road Traffic Accident Fatalities in Karachi, Pakistan: An Autopsy-Based Study

Abstract

Background Road traffic accident (RTA) fatalities account for a significant number of unnatural deaths in Pakistan. Hence, it is necessary to investigate RTA fatalities in order to implement measures to reduce them. In the present study, we aimed to assess the detailed epidemiological characteristics of RTA fatalities by analyzing the data obtained from medico-legal autopsies performed at the Jinnah Postgraduate Medical Centre (JPMC) in 2019 and 2020. We assessed age- and gender-based variations in the pattern of RTA fatalities and determined the anatomical cause of death and sites of fractures among the fatalities. Moreover, we assessed the monthly distribution of cases in 2019 and 2020 to determine the impact of the coronavirus disease 2019 (COVID-19) on the number of RTA fatalities reported each month. Methodology In this retrospective study, data obtained from medico-legal autopsies of all RTA victims in 2019 and 2020 (n = 246) were collected from the Forensic Department of JPMC, Karachi. The data were then entered into Statistical Package for the Social Sciences version 24.0 (IBM Corp., Armonk, NY, USA) for analysis. Results The highest number of fatalities was recorded in the age group of 18-40 years (54.5%), while the lowest number was recorded in the age group of ≥60 years (8.5%). The male:female autopsy ratio was 6.03:1. Most fatalities were recorded from 6:00 am to 11:59 am (41.9%), followed by 12:00 pm to 5:59 pm (37.4%). Moreover, most victims (76.8%) died instantaneously within seconds to minutes of the incident. The number of RTA fatalities reported in 2019 (50.4%) was similar to that reported in 2020 (49.6%). However, the number of RTA fatalities reported in March-July 2020 was 35.6% lower than that reported in the same period in 2019, possibly because of the restrictions (such as lockdowns) that were imposed to control the spread of the COVID-19 pandemic in 2020. There was a statistically significant difference in the number of RTA fatalities reported in March-July 2020 and that reported in the remaining months of 2019 and 2020 (p = 0.006). The cause of death was head injury in 159 (64.6%) cases and multiple traumatic injuries in 65 (26.4%) cases. Injury to the chest, abdomen, and pelvis caused death in 11 (4.5%), nine (3.7%), and two (0.8%) cases, respectively. Assessment of the site of fractures revealed skull fractures to be the most common type of fractures (53%), followed by rib/sternal fractures (19%). Upper limb and lower limb fractures occurred in 10% and 9% of the cases, respectively, while pelvic and neck fractures occurred in 6% and 3% of the cases, respectively. Conclusions Efforts need to be made at both government and individual levels to reduce RTA fatalities. Strict implementation of traffic laws is necessary. Although we noted a male preponderance, the reluctance to get females autopsied should not be disregarded. The significant decrease in RTA fatalities during March-July 2020 could be attributed to the reduced traffic burden due to the restrictions imposed to control the COVID-19 pandemic and the preventive measures taken, such as staying at home, to avoid contracting the virus.