Johann Peter frank labeled injury as public health problem way back in 1788(5). J.E. Gordon attributed seasonal variations, long term trends and demographic distribution to injuries in 1949(6). Energy from different sources was attributed to energy in any form by James Gibson in 1961 [1].
World Health Organization mentioned that 90% of the injuries occur in low income and middle-income countries, may be because of the poor overall infra structure and lack of health care facilities available in comparison to the developed countries [2].
Almedia et al in 1999 studied epidemiological patterns of musculoskeletal injuries and physical training. They found that the volume of physical training is an etiological factor for exercise related injuries. He suggested that type of training particularly running and abrupt increase in training volume contribute to injury [3].
In 2007, Akama et al studied the pattern of maxillofacial and associated injuries in road traffic accidents. They found that the males in the 21-30-year age group were the most affected. Most accidents were caused by passenger service vehicles which were responsible for 62% and 40.6% of non-fatal and fatal injuries respectively. Non-use of safety belts was reported in 56.6% of the cases who suffered non-fatal injuries. In the non-fatal category 89.6% of the casualties had soft tissue injuries (STIs) involving the craniofacial region with facial cuts being the majority (69.2%). 66.1% incidents other than those of the head region were noted, the lower limbs accounting for 45.4% of these. Only 5.1% of the casualties with non-fatal injuries had fractures involving the maxillofacial skeleton. Skeletal injuries other than those involving the maxillofacial region were found in 142 (34.1%) incidents. In the fatal category head injury alone was the leading cause of death accounting for 37.7% of the cases followed by head and chest injuries combined which were responsible for 13% of the cases [4].
In 2011, Kavita et al described the burden, characteristics, and outcome of injury among females in India. They found that females across all age groups accounted for 26% of fatal and 23% of nonfatal injuries and the highest numbers were among those 16 to 45 years old. Burns and hanging were the leading causes of death; road crashes and poisonings were the major causes of nonfatal injuries. Nearly half of the fatal and one third of the nonfatal injuries were suicides. Pedestrians and two-wheeler riders/pillions were mainly involved in road crashes. Very few received first aid at the injury site and the commonest modes of transportation were a private vehicle or taxi and the local three-wheeler vehicle. More than half of the injured were admitted in the hospitals for medical or surgical management [5].
Bihari et al (2011) studied 2086 patients of both sexes in National Capital region (NCR). He studied musculoskeletal pain and associated risk factors. He attributed Chronic Musculoskeletal pain not only to injuries but also to inflammatory conditions like arthritis, gout and metabolic diseases [6].
In 2012, Peck et al studied the epidemiology of intentional burns among the adults throughout the world. Rates of intentional burns are unevenly distributed throughout the world; India has a particularly high rate in young women whereas in Europe rates are higher in men in mid-life. Data from hospitalized burn patients worldwide reveal incidence rates for assault by fire and scalds ranging from 3% to 10%. The average proportion of the body surface area burned in an assault by fire or scalds is approximately 20%. In those who resort to self-immolation, circumstantial themes reflect domestic discord, family dysfunction, and the social ramifications of unemployment [7].
In 2012, Uthkarsh et al studied the profile of injury cases admitted to a tertiary level hospital in South India. They found that the mean age of the study population was 35.3 years (SD = 15.38), 69.1% were injured in road traffic accidents (RTA), 28.7% due to falls and 2.2% due to burns. Nearly 14.4% were under the influence of alcohol. Nearly 73.6% of RTA cases were two-wheeler users, 48.5% had not followed sign boards and 56.5% had not obeyed the one-way rules, 63.5% of the two-wheeler users did not use helmets. Also, 38% of two wheelers had two pillion riders, whereas 57% of four-wheeler users had not used a seat belt. Among falls, 58% occurred at home, 49% occurred due to slippery surface. Road traffic accidents were the most common cause for injuries, in which two wheelers were most commonly involved [8].
In 2014, Rastogi et al described the epidemiology of patients admitted to a major trauma centre in North India. They found that injuries occurred predominately in the age group of 15-30 years. Males incurred more injury with male to female ratio of 6:1. The most vulnerable group was motorcycle users. Among the injured, farmers were the most commonly involved. Blunt injuries (94.92%) were much more common than penetrating injuries. Among patients with head injury, two-wheeler related accidents were the most common (40.3%). Most spinal cord injuries were caused by falls from height (51.09%). Most lower limb fractures were simple type. Compound fractures of the lower limb were more common than upper limb fractures [9].
Hussain et al (2015) studied the pattern and epidemiology of pediatric musculoskeletal injuries in Kashmir valley. The authors found that most injuries were sustained because of fall while playing (34.76%), fall from height (33.74%), road traffic accidents (14.92%), and fall from standing height (7.97%). The majority of injuries were caused by unintentional trauma. The places where injury occurred were the home (41.10%), play field and orchards near the home (30.67%), roads (14.92%), and school (12.47%). They concluded that a safer environment and better playing conditions might decrease the high frequency of trauma in pediatric patients [10].
Vasanth et al. (2015) studied the prevalence, pattern and factors associated with work related musculoskeletal disorders among tea associated with work related musculoskeletal disorders among pluckers in a tea plantation in Tamil Nadu. They concluded that the prevalence was high among pluckers, the common sites being shoulder and lower back. Increase in age and duration of employment was associated with WRMDs [11].
Paul et al conducted a community based cross sectional study from Sept to November 2017 in a single development block of West Bengal. They concluded that MSDs was high in farming community with low rate of health care utilization. These workers were affected in the region of low back and lower region that interfered with the occupational activities as well as routine activities. They concluded that health care system should provide emphasis on provision of necessary support services for the primary and secondary prevention of MSDs in Indian farmers [12].
In 2017, Awasthi et. al in a study on injuries due to fall found that fracture distal radius was the most common fracture of upper limb followed by fracture both bones and supra condylar fracture. In lower limb intra trochanteric fracture was the most common [13].
In 2017, Aghajani et al studied the epidemiological pattern of injuries in Iran by conducting a review of seven million emergency department admissions. 7,176,344 patients with the mean age of 27.5 ± 17.8 years were registered to 657 EDs (70.6% male). Road Traffic Crash (RTC) was the most common cause of injury (31.0%) followed by hit (28.2%) and fall (10.1%). While roads were the commonest place of injuries, 34.0% of patients have been injured at home. More than 90% of injuries were unintentional. Assault and suicide attempt were causes of injury in 5.6% and 3.9% of patients, respectively [14].
In 2018, Singh et al studied the epidemiology of pediatric musculoskeletal injuries and their pattern in a tertiary care center of North India. They concluded with identification of importance of need for more supervision of children during playing and identification of specific risk factors. It was found that upper limb injuries were more common followed by lower limb. Superficial injuries like abrasions and bruises were more common. Age group was 6-15 years and 12% were poly trauma patients [15].
Gupta et al (2019) with an aim to establish the value of trauma registry by measuring, monitoring and analyzing the etiological factors, studied 6574 patients in emergency department and found that the most common injury was fracture of bone (65.38%) with commonest site being lower limbs in 41.34%. Most common associated injury was head injury in 5.33% with maximum incidence in 30–59-year age group. He concluded that fractures are the most common pattern of injury associated with other injuries especially head injury. He emphasized the importance of age group and time factor and the need for medical facilities along highways [16].
In 2019, Abhilash et al studied the injury patterns and outcomes of trauma in the geriatric population presenting to the emergency department in a tertiary care hospital of South India.The mean age was 69 (standard deviation: 6.76) years with 87.6% being young-old (60-79 years) and 12.4% being old-old (>80 years). Majority (63.2%) were Priority 2 patients. The median time between the incident and ED arrival among Priority 1 patients was 3 h (interquartile range: 2-5). Common modes of injuries were slip and fall (37.4%), two-wheeler accidents (25.8%), fall from height (9.1%), and pedestrian (8.9%). The ED team alone managed 25.8% of patients. Specialty departments referred to included orthopedics (48%), neurosurgery (18.3%), plastic surgery (4.2%), HLRS (4%), and others. Injuries due to slip and fall were significantly more among the old-old (P = 0.001), and two-wheeler accidents were more among the young-old (P = 0.001), respectively. Superficial head injuries (28.8%), extremity (24.8%), facial (18.7%), and traumatic brain injuries (17.8%) were common presentations. Thoracic injuries were significantly more among the old-old (P < 0.001) [17].
In 2019, Onyemaechi studied the pattern of surgical emergencies in a Nigerian tertiary hospital. There were 575 surgical emergencies which constituted 56.8% of surgical admission, and 27.2% of all emergency hospital admissions. The commonest trauma cases were soft tissue injuries (30.3%), while the commonest non-trauma case was acute abdomen (41.6%). The mean age of the patients was 33.7 ± 17.2 years. Multiple injuries and traumatic brain injuries requiring intensive care monitoring, and malignancies were associated with higher mortality rates (p = 0.001). The 1-year mortality rate was 7.8% and the preventable death rate (PDR) for the trauma-related emergencies was 71.4% [18].
In 2019, Ngunde et al conducted a hospital based prospective cross-sectional study to determine the prevalence and pattern of lower extremity injuries due to road traffic crashes in Cameroon. They found that the majority of crash victims were in their 3rd and 4th decades of life. The prevalence of lower extremity injuries from Road Traffic Crashes was 47.93%. The most vulnerable road users were pedestrians (26.52%) and passengers on motor bikes (38.44%) and the commonest mechanism by which crash victims sustained injuries were: bike-car collisions (22.84%), and bike-pedestrian collisions (19.29%). Commercial motor bikes (62.77%) and taxis (22.38%) were the road users most involved in road traffic collisions. The leg 98(49.75%), thigh 23(11.68%), and knee 20(10.15%) were the most injured anatomical parts of the lower extremity. Fractures 68 (34.52%), lacerations 53(26.90%), and bruises 49(24.87%) were the most recurrent pattern of lower extremity injuries [19].
Dkhar et al (2019) conducted a retrospective study on the profile of long bone injuries in trauma patients presenting to the emergency department in a medical college in South India. They found that male (71.8%) predominance was there. The mean age was 45.7 (±17.9) years. Road traffic accident (68.35%) was the most common mechanism of the incident followed by slip and fall (20.56%). Majority of patients (43.98%) came during 3 pm and 10 pm. The most common long bone injured was the tibia in the young (51.68%)- and middle-aged (58%) patients. In the elderly, femur (58.19%) was the most common bone involved. Head injury accounted for 13% of the associated injuries. 57.37% patients had to undergo an emergency operation on the same day of arrival, whereas 78 (42.62%) patients were managed conservatively in the wards or had an elective surgery done at a later date.
Rehman et al (2020) conducted a cross-sectional analytical study to estimate the prevalence and determine the pattern of domestic accidents in the field practice area of Jawaharlal Institute of Urban Health Center, Puducherry. The authors found that the prevalence of domestic accidents was 10.2% in the present study. It was reported mostly among the adults and in the kitchen, with falls being the most common cause and upper limbs injury being commonest. Most of the houses had objects lying scattered on the floor hindering movement; and stoppers and grab bars were missing from the doors and bathrooms respectively. Overcrowding was significantly associated with domestic accidents [20].
Harna et al (2020) described the epidemiology of trauma patients admitted to a trauma centre in India. The data depicted the RTAs as the most common cause affecting adults between 20 years and 40 years. The study reports other risk factors like alcohol intoxication and motorcycle riders. Mostly, the patients present in a semiconscious and disoriented state requiring fluid resuscitation. Abrasions and bruises in the extremities stand out as the most common injury pattern. The fractures suffered were the most common injury suffered by the patients [21].
Tiruneh et al (2020) studied the pattern of injury admissions in a tertiary care hospital on weekends as compared to weekdays. Compared with weekday admissions, weekend and weeknight admissions had higher risk of hospitalization from violence and fall-related injuries, but lower risk from road traffic injuries (RTI) except for weekend-day admissions adjusted for age, gender, and ethnicity. Hospitalization due to burn injuries was greater on weekends, particularly on weekend-days. Hospitalization for violence and burn injuries was greater on weekend-nights as compared to weeknights, while injuries from other unintentional causes were greater on weeknights than weekend-nights. On stratified analyses, RTI-related hospitalization was greater on weekends among youth and adults aged 15-64 years, and males, while burn injuries were more likely among weekend admissions for children aged 0-14 years, and females [22].
Lohanathan et al (2020) described the pattern of injuries in patients with fall from height in a tertiary care hospital in India. The authors found that the mean age was 36.2 (SD 20.8) years. A male predominance (74%) was noted. Majority of the patients, i.e., 62%, were triaged as priority 2, depending on the hemodynamic stability. Approximately a quarter (26%) sustained injury to the lower limbs with 18% sustaining spinal cord injury (SCI). Among the patients suffering SCI (35%), patients were further categorized in the American Spinal cord Injury Association (ASIA) classification. New Injury Severity Score (NISS) was more than 8 in 47% of the total study population. Majority of the patients, i.e., 62%, were discharged stable from ED after primary care with a plan of follow-up in the outpatient department. One-third (30%) of the total patients required hospital admission and among them 20% of the patients had to undergo major surgical intervention [23].
In 2021, Yin et al identified and compared intentional and unintentional injuries among children and adolescents in China. A total of 81,459 (95.1%) unintentional injuries, 4,218 (4.9%) intentional injuries (4,013 violent attacks and 205 self-mutilation/suicide) cases were identified. Blunt injuries accounted for 59.4% of violent attacks, while cuts and poisoning accounted for 37.1% and 23.4% of injuries involving self-mutilation/suicide, respectively. For unintentional injuries, falls (50.4%) ranked first. Additional risk factors for intentional injuries included being male (odds ratio [OR] 1.6), coming from rural areas (OR 1.9), being staff or workers (OR 2.2), and being a student (OR 1.8). As the age of the patients increased, so did the risk of intentional injuries (OR 5.0 in the 15-17 age group). Intentional injuries were more likely to occur at 00:00-03:00 am (OR 2.0) [24].
In 2021, Nwashilli studied the pattern and outcome of stab injuries in a tertiary care hospital in Nigeria, retrospectively. The mean age of the study participants was 31 years, and most of them were males, with a male to female ratio of approximately 13.5: 1. Most stabs occurred in the third decade with chest being the most common body region. Conflict/fight was the most common reason for stab with broken bottle being the most common weapon. The average duration of hospital stay was 6 ± 3.99 days. There was no mortality [25].
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