Objective: To explore the characteristics and mechanisms of serious injuries of chest caused by road traffic accidents. Methods: Totally 112 autopsy cases with chest injuries in the urban of Jingzhou road traffic accidents were collected. Systematic review and analysis of the general information, postmortem examinations and assessments of chest injury had carried out from Feb. 2016 to Mar. 2018. Results: Average age of the victims was 52.2 years and the ratio of male to female deaths was 2.39:1. The proportion of motor-cyclists and pedestrians increased significantly. The overwhelming majority of accident vehicles were motorcycles and bicycles. Fractures of ribs and pulmonary contusion were the most common injuries. Craniocerebral and abdominal injuries were the most common associated injuries. Conclusion: Fractures of ribs and pulmonary contusion were the most common features of fatal road traffic injuries, often associated with vitreoretinal damage and serious multiple damages. These features reflect the characteristics of great violence in traffic accidents, which provides the evidence of identification of violent injuries.
Injuries of the chest are commonly shown as rib fractures, heart and large vascular injuries, lung parenchymal injury, chest compression and asphyxia, etc. Since the 1990s, it is an important cause of death after traumatic brain injury. In the traffic accidents, the chest injury accounted for 44.5% of the total number of injuries and a quarter of the total number of deaths caused by injuries [
Death cases of traffic accidents in Jingzhou area accepted by the author’s organization from Feb. 2016 to Mar. 2018 were selected, in which 112 deaths with chest injuries were screened out to collect relevant information including the general data of the deceased, on-site inspection data, medical records and postmortem examination data. The screening conditions are: 1) The autopsy and related examinations confirmed that the cause of death was clear and all due to road traffic accidents. 2) The data was complete. There were complete on-site inspection data, accident spot map, vehicle examination data, trace examination data and relevant clinical data. 3) Each case is subject to on-site inspection, image data and trace examination to clarify the form of the accident and the relationship between the driver and the passenger.
For the selected cases, the systematic postmortem examination was carried out with reference to “Examination of cadavers surface in forensic medicine” (GA/T149-1996), “Autopsy in forensic medicine” (GA/T147-1996) and “Methods of collecting, fixing, collecting and sending for forensic pathological materials” (GA/T148-1996). Cranial, thoracic, abdominal, pelvic organs were taken conventionally according to the operational specifications for pathological examinations and analysis [
The 112 deaths were aging from 4 to 82 years old, with an average of 52.2 years; there were 79 males (70.54%) and 33 females (29.46%), and the ratio of male to female was 2.39:1; the average age of males was 52.94 years old, while that of females was 54.28. The peak of the accidents occurred in July-October each year. There was a sum of 65 deaths in the four months, accounting for 58.04% of the total deaths in the year.
Among the 112 deaths, the proportion of motorcyclists and pedestrians increased significantly. There were 10 (8.93%) car drivers and 7 (6.25%) front (rear) passengers, a total of 17 cases (15.18%); the number of two-wheel (three-wheel) motorcycle (hereinafter referred to as motorcycles) drivers was 39 (34.82%) and that of passengers was 8 (7.14%), a total of 47 cases (41.96%); there were 16 (14.29%) bicycle drivers and 3 (2.68%) passengers (25.89%); the number of pedestrians was 29 (25.89%). The statistical results of the deaths of various types of traffic mode were shown in
A total of 166 accident-causing vehicles were involved, and the proportion of motorcycles and small cars increased significantly. Among them, 69 motorcycles accounted for 41.6%, 38 large vehicles for 22.9%, 48 small cars for 28.9% and 11 bicycles for 0.07%. There were a total of 86 vehicles, accounting for 51.8%.
Among the 112 deaths with the chest injury caused by road traffic accidents, rib fractures (a total of 92 cases, accounting for 82.14%) and lung contusions (a total of 79 cases, accounting for 70.54%) were the most common. The proportion of motorcyclists and pedestrians increased significantly. The relationship between the cause of chest injury and different traffic modes was shown in
| Type of the injury | Traffic mode of the deceased | Total (%) | |||
|---|---|---|---|---|---|
| Automobile | Motorcycle | Bicycle | Pedestrian | ||
| Driver (passenger) | Driver (passenger) | Driver (passenger) | |||
| Rib fracture | 9 (3) | 38 (3) | 12 (3) | 24 | 92 (82.14) |
| Hemothorax | 3 (2) | 8 (2) | 3 (1) | 6 | 25 (22.32) |
| Pneumothorax | 3 (0) | 7 (0) | 1 (1) | 4 | 16 (14.29) |
| hemopneumothorax | 4 (2) | 17 (4) | 9 (2) | 9 | 38 (33.93) |
| Myocardial contusion | 3 (1) | 11 (3) | 3 (1) | 8 | 30 (26.79) |
| Cardiac rapture | 6 (3) | 8 (3) | 8 (2) | 10 | 39 (34.82) |
| Lung contusion | 10 (5) | 27 (7) | 8 (3) | 19 | 79 (70.54) |
| Lung rapture | 4 (3) | 18 (4) | 6 (2) | 14 | 51 (45.54) |
| Sterna and clavicle fracture | 4 (0) | 11 (2) | 8 (2) | 3 | 30 (26.79) |
| Scapular fracture | 3 (0) | 4 (3) | 4 (1) | 4 | 19 (16.96) |
| Thoracic vertebrae injury | 1 (0) | 6 (3) | 3 (0) | 12 | 25 (22.32) |
| Thoracic vascular injury | 5 (2) | 9 (2) | 5 (2) | 7 | 32 (28.57) |
| Type of the fracture | Traffic mode of the deceased | Total (%) | |||
|---|---|---|---|---|---|
| Automobile | Motorcycle | Bicycle | Pedestrian | ||
| Driver (passenger) | Driver (passenger) | Driver (passenger) | |||
| Bilateral multiple rib fractures | 7 (1) | 20 (4) | 6 (1) | 14 | 53 (47.32) |
| Unilateral multiple rib fractures | 2 (1) | 8 (4) | 5 (1) | 7 | 28 (25.00) |
| Unilateral single rib fracture | 0 (1) | 2 (3) | 1 (1) | 3 | 11 (9.82) |
| Total | 9 (3) | 30 (11) | 12 (3) | 24 | 92 (82.14) |
| Type of the associated injury | Traffic mode of the deceased | Total (%) | |||
|---|---|---|---|---|---|
| Automobile | Motorcycle | Bicycle | Pedestrian | ||
| Driver (passenger) | Driver (passenger) | Driver (passenger) | |||
| Associated craniocerebral injury | 9 (6) | 33 (6) | 12 (2) | 23 | 101 (90.18) |
| Associated abdominal injury | 6 (2) | 28 (3) | 7 (2) | 17 | 65 (58.04) |
| Associated pelvic injury | 1 (2) | 11 (4) | 3 (1) | 6 | 30 (26.79) |
| Associated lower limbs fracture | 1 (2) | 22 (6) | 8 (2) | 14 | 55 (49.11) |
| Total | 17 (12) | 61 (13) | 18 (5) | 37 | 163 (145.54) |
Among the 112 deaths in road traffic accidents, there were significantly more males than females, and the ratio of male to female was 2.39: 1 which is similar to the ratio of male to female deaths in traffic accidents in medium-sized cities in China [
From the traffic modes of the deceased and the types of vehicles involved, pedestrians and motorcyclists have become the most vulnerable road users, and the injuries are mainly caused by small cars and motorcycles. The analysis indicates that it is related to the rapid increase in the purchase of small cars and the fact that the use of motorcycles (electric motorcycles) was not effectively controlled in Jingzhou. The lack of education on road traffic safety consciousness and the inability to keep up with the progress of traffic modes are also important causes of accidents.
Chest trauma accounts for up to 10% - 15% of all traumas, and in the world, the chest trauma accounts for 25% of the death cases caused by trauma [
In addition to chest injuries, the 112 deaths in road traffic accidents often have associated injuries, most common in head and abdomen injuries. Most of them have characteristics of light injury on one side of the body and heavy injury on the other side. Within this study, the motorcyclist’s associated injury was particularly prominent. The head, abdomen, pelvis and lower limb injuries were not uncommon. It suggests that for the relevant population, the possibility of the multi-system and multi-organ combined injury should be highly valued during emergency treatment, and the corresponding treatment measures should also be developed.
In view of the wide range of injuries caused by traffic accidents, the complex injuries and the most common joint injuries of multiple organ systems, the identification of injuries in cadavers surface and autopsy examinations has great limitations. It is still necessary to combine the vehicle, trace and on-site examinations and other comprehensive analyses to lead to objective and true identification results.
The authors declare no conflicts of interest regarding the publication of this paper.
Zhang, Y.X., Quan, X.L., Tang, H. and Lei, Y.W. (2020) Analysis of Thorax Injuries in 112 Death Cases Caused by Traffic Accidents. Yangtze Medicine, 4, 125-131. https://doi.org/10.4236/ym.2020.42012