AN AUTOPSY BASED COMPARATIVE STUDY OF PATTERN OF INJURIES IN PEDESTRIANS INVOLVED IN RAILWAY TRACK DEATHS.

Background: The purpose of all accident investigations is to establish the cause of the incident. This information will be sought for a number of reasons which may overlap. The victims or their families may want to see what can be done to prevent recurrence. The patterns of injuries in railway track deaths may vary according to the position of the person or the different situations when struck. In forensic literature only few systematic studies of the respective injury pattern are available. In many instances the forensic pathologists are asked to reconstruct the event after medicolegal autopsy. Hence an attempt is made to study the pattern of injury in pedestrians involved in railway track incidences with relative position of victim and train so that this study may help the forensic pathologist to reconstruct the events and rule out foul play. Materials and methods: A cross sectional study of all railway track deaths brought for medicolegal autopsy at Thiruvananthapuram Medical College, Kerala, from 1st March 2010 to 28th February 2011 were analyzed. A total of 104 cases of railway track deaths were studied excluding cases with advanced decomposition. Data regarding nature of incidents were collected from the Kerala Police Form 102 (KPF 102), investigating officers and relatives. Clinical case records were studied in treated cases. A meticulous external and internal examination was made and the details regarding nature, dimensions and location of injury was entered in a proforma. The data were entered in MS Excel and statistical analysis was done. Results: Among 104 cases of railway accidents in the study period 17 (16.3%) cases were those with history of hit by train while they were walking along the side of or through the track (GROUP I) and 34 (32.7%) cases were those with history of crossing the track (GROUP II). All the cases showed external injuries. In all cases of Group I , there was lacerated wound on the head, and in 82.4% external injury was present on the face also. Among these, 6 cases (35.3%) showed crushed lacerated wounds on the head and face. In 14 cases (82.4%) there was skull fracture. Facial bone was fractured in 52.9% of cases and showed intracranial haemorrhages associated with skull fracture. Injury to brain was seen in 17.6% of cases. Two(11.8%) cases showed fatal neck injury, one was a case with decapitation injury and the other showed fracture of the cervical spine with contusion of the cord. Nine cases (52.9%) showed injury to chest and 8 among them (47%) showed injury to abdomen also.. Thoracic spine was fractured in 23.5% of cases. Transection had occurred in 2 cases (11.8%) . The most prominent injury in group II was lacerated wound (91%). Head and face were injured in 31 cases (91%). In this, 9 cases (26.5%) showed fracture fragmentation of skull bone with extrusion of the brain. Skull fracture was seen in 18 cases (52.9%). Out of which, Intra cranial haemorrhage was present in 8 cases (23.5%) and another 2.9% showed isolated intra cranial haemorrhage. Brain showed injury in 9 cases (26.5%).Decapitation was seen in 6 cases (17.6%). In 7 cases (20.5%) soft tissue injury with cervical spine fracture was seen. One case (2.9%) showed only soft tissue injury on the neck region. Chest and abdomen were injured in 38.2% cases and 32.4% showed chest injury alone. Abdominal injury alone was present in one case, that too was a transection injury. In 20 cases (58.8%) ribs were fractured. Sternum and thoracic spine were fractured in 4 (11.8%) and 8 (23.5%) cases respectively. The chest viscera were injured in 10cases (29.4%) .Lumbar spine was fractured in 2.9 % of cases. Conclusion: Head injuries were common in cases with history of crossing the track. Cases with history of walking along the side of or through the train showed characteristics pattern of lacerated wound with fracture on the back of head. Transection injuries were common in cases with history of walking along the track and while crossing the track. In cases with history of crossing the track, most of the injuries were distributed on the upper part of the body. In the case where hit occurring in the upright position, lacerated wounds can be caused on the upper part of the body due to hitting against the projecting parts of train like buffer head, hand rail, or platform in front of loco engine.