1
|
Franceschetti L, Galante N, Ciprandi B, Benini B, Mazzarelli D, Cattaneo C. Identification issues in bodies maimed by train fatalities: The role of the forensic pathologist. Forensic Sci Med Pathol 2023; 19:517-524. [PMID: 36662408 DOI: 10.1007/s12024-022-00571-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/21/2023]
Abstract
Traffic accident injuries are relevant causes of mortality in industrialized countries. Among traffic accidents, the most destructive effect on the victim's body is produced by trains, which in a very short time provoke a complete distortion of the normal anatomical profiles and extensive amputations of the body. Deaths by severe body mutilation and/or decapitation require complex forensic investigation, as the victims' identification and the recognition of their body are not often feasible. In this study, a retrospective analysis of a series of cases of railway accidents is presented, with the aim of showing potential identification strategies, including a systematic physical re-assembling of the body. Among the railway fatalities assessed at the University Institute of Legal Medicine of Milan from 2016 until 2020, 61 cases were analyzed, focusing on the collection of postmortem data to improve accuracy for the identification of the victims. The results showed that the identification could be based on elements traditionally called "secondary identifiers" which, however, are becoming more and more important for positive identification, especially when dealing with migrants, vagrants, and homeless people. However, several issues need to be considered such as the limitations of the public prosecutors to perform expensive analyses (i.e., genetic testing), and the lack of antemortem data to be compared with postmortem findings, both odontological and fingerprint. In cases where it is not possible to proceed with identification or formal recognition of victims of railroad accidents with severe mutilations, a systematic physical re-assembling of the body is critical to reaching positive identification.
Collapse
Affiliation(s)
- Lorenzo Franceschetti
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy.
| | - Nicola Galante
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy
| | - Barbara Ciprandi
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy
| | - Benedetta Benini
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy
| | - Debora Mazzarelli
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy
| | - Cristina Cattaneo
- LABANOF, Laboratorio di Antropologia e Odontologia Forense, Dipartimento di Scienze Biomediche per la Salute, Istituto di Medicina Legale, Università degli Studi di Milano, via Luigi Mangiagalli 37, Milan, 20133, Italy
| |
Collapse
|
2
|
Kutela B, Kidando E, Kitali AE, Mwende S, Langa N, Novat N. Exploring pre-crash gate violations behaviors of drivers at highway-rail grade crossings using a mixed multinomial logit model. Int J Inj Contr Saf Promot 2022; 29:226-238. [PMID: 35132936 DOI: 10.1080/17457300.2021.1990348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The highway-rail grade crossings (HRGCs) across the United States have been experiencing about 2500 crashes each year. Previous studies analyzed crash frequencies and fatalities; however, factors pertaining to drivers' gate violation behaviors are little known. Also, applied methodologies for gate violation behaviors analysis did not consider their heterogeneity across regions. This study uses 20-year of crash data (1999-2018) to evaluate pre-crash drivers' behaviors at HRGCs. A mixed multinomial logit model was developed to associate such behaviors with demographic factors, vehicle characteristics, temporal and environmental factors, as well as crossing-related factors. The study results indicated a high intra-class correlation coefficient which signifies the importance of including the random-effect parameter in the model. Further, the study found that male drivers are more likely to drive around the gate, while older drivers are more likely to stop and proceed before a train has passed. Furthermore, compared to trucks, all other vehicle types are more likely to drive around the gate. The influence of train speed, vehicle occupancy, visibility, among others, on drivers' pre-crash behaviors, is also presented. Understanding the impact of these factors on pre-crash behaviors may assist in improving the motorist's safety at the highway-rail grade crossings across the United States.
Collapse
Affiliation(s)
- Boniphace Kutela
- Roadway Safety Program, Texas A&M Transportation Institute, Bryan, TX, USA
| | - Emmanuel Kidando
- Department of Civil and Environmental Engineering, Cleveland State University, Cleveland, OH, USA
| | - Angela E Kitali
- Department of Civil and Environmental Engineering, Florida International University, Miami, FL, USA
| | - Sia Mwende
- Department of Civil Engineering, Ardhi University, Dar es SalaamTanzania
| | - Neema Langa
- Department of Sociology, University of Nevada, Las Vegas, NV, USA
| | - Norris Novat
- Department of Civil Engineering, Ardhi University, Dar es SalaamTanzania
| |
Collapse
|
3
|
Pennell C, Lindholm E, Latreille J, Kadakia S, Nanassy A, Ciullo S, Arthur LG, Grewal H, Prasad R. Pediatric Train Injuries: A 10-Year Review From the Pennsylvania Trauma Outcomes Study Database. Pediatr Emerg Care 2022; 38:70-74. [PMID: 34618417 DOI: 10.1097/pec.0000000000002351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Trains can cause severe injuries in pediatric patients requiring significant resource utilization. We sought to review train injuries in Pennsylvania to determine the burden of these injuries on the pediatric trauma system. METHODS We queried the Pennsylvania Trauma Outcomes Study Database to identify patients younger than 18 years injured by trains between 2007 and 2016. Demographics, hospital course, outcomes, and resource utilization were reviewed. RESULTS Thirty-five children from 17 Pennsylvania counties were included. Three counties accounted for 48.6% of injured children. The median age was 15.0 years, and most patients were White (60.0%) and male (77.1%). The median length of stay was 8.0 days and overall mortality 8.6%. Intensive care unit admission was required for 65.7%. The median Injury Severity and Functional Status at Discharge scores were 14.0 and 18.0, respectively. Major orthopedic injuries (fracture or amputation) were the most common (57.1%) followed by traumatic brain injury (45.7%), pneumothorax (14.3%), and solid organ injury (14.3%). Operative management was common with 65.7% undergoing surgery. CONCLUSIONS Injuries caused by trains can be severe and are most commonly orthopedic or traumatic brain injuries. Targeted safety interventions may be possible given the common mechanisms and geographic clustering of these injuries.
Collapse
Affiliation(s)
- Christopher Pennell
- From the Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, St Christopher's Hospital for Children
| | - Erika Lindholm
- From the Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, St Christopher's Hospital for Children
| | | | | | - Autumn Nanassy
- From the Department of Pediatric General, Thoracic, and Minimally Invasive Surgery, St Christopher's Hospital for Children
| | | | | | | | | |
Collapse
|
4
|
Kontoghiorghe CN, Graham SM, Rodriguez J, Matzopoulos R, Maqungo S. Train related injuries: A descriptive analysis highlighting orthopaedic injuries and management. SICOT J 2021; 7:43. [PMID: 34402792 PMCID: PMC8370016 DOI: 10.1051/sicotj/2021038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Orthopaedic injuries constitute a major aspect of morbidity and mortality following train accidents. The pattern of orthopaedic/musculoskeletal injuries sustained following these accidents has not been fully characterised. The main aim of this study is to describe the range of orthopaedic injuries reported in a major trauma centre and evaluate their management, as well as reporting mortality and amputation rates. Further aims are to identify the social and demographic background of the patients to suggest treatment and prevention strategies. Methods: This study is a retrospective observation of all clinical files of patients presented to Level 1 Trauma Centre in Cape Town, South Africa, as “train casualty” from January 2013 to July 2019, which were reviewed and evaluated. A total of 174 patients were included, of which 92 were orthopaedic referrals. The average age was 29 years, and 87% were male. Results: Tibial fractures were most common (N = 19), 38% of patients sustained open fractures, and 68% of patients (in total) underwent surgery. Wound debridement was the most common operation, followed by open reduction internal fixation (ORIF). Twelve patients (13%) underwent amputation to 14 body parts. Eight patients (4.6%) (in total) died in the trauma unit. Discussion: This study provides insight into train accident victims and their orthopaedic injuries and management patterns. The victims are largely young males. The majority of orthopaedic injuries require surgical intervention, and those who make it to the hospital have a good chance of survival and limb salvage. It appears that in addition to early hospital access and specialised updated treatments, morbidity and mortality in train accidents could be reduced by improving safety measures and social awareness to reduce railway violence and accidents.
Collapse
Affiliation(s)
- Christina Niovi Kontoghiorghe
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - University College London Hospitals NHS Foundation Trust, NW1 2BU London, UK
| | - Simon Matthew Graham
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - Institute of Population Health Sciences, University of Liverpool, L69 3BX Liverpool, UK - Department of Orthopaedic and Trauma Surgery, Liverpool University Teaching Hospital Trust, L9 7AL Liverpool, UK
| | - Joel Rodriguez
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - University of Texas Southwestern Medical Center, Dallas, 75390 TX, USA
| | - Richard Matzopoulos
- Burden of Disease Research Unit, South African Medical Research Council, 7505 Cape Town, South Africa - School of Public Health and Family Medicine, University of Cape Town, 7925 Cape Town, South Africa
| | - Sithombo Maqungo
- Division of Orthopaedic Surgery, Groote Schuur Hospital, 7935 Cape Town, South Africa - Division of Global Surgery, University of Cape Town, 7925 Cape Town, South Africa
| |
Collapse
|
5
|
Bagaria DK, Banerjee N, Gupta A, Kumar S, Mishra B, Choudhary N, Kumar A, Priyadarshini P, Sagar S, R M Pandey. Train-Associated Injuries Pose a Significant Burden on Trauma Care Systems of Emerging Economies. World J Surg 2021; 44:2993-2999. [PMID: 32383056 PMCID: PMC7224012 DOI: 10.1007/s00268-020-05563-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Indian railway system is the fourth largest in the world and causes about 15 deaths every day, due to intentional or unintentional reasons. This study presents a 5-year retrospective analysis of patients injured due to train-associated events, managed at a level-1 trauma center in India. MATERIALS AND METHODS Hospital-based trauma registry data of train-associated injuries presenting between 2012 and 2016 were analyzed. Data from 726 patients were analyzed for demographics, injury events, injury regions, their management and outcomes. ISS and NISS were used to quantify the injury severity. RESULTS Mean age was 33 years, with male-to-female ratio 86 to 14%. The majority of patients (62%) were between 20-40 years. The median ISS was 9 (IQR 4-16), median hospital stays 11 days (IQR6-23), with in-hospital mortality of 17.4%. Presence of head injury; ISS > 9 and CPR in ED were independent risk factors of mortality. Trespassers on the rail track had significantly more severe injuries compared to passengers (Median ISS 13 vs. 9, p = 0.012; Median NISS 22 vs.17, p = 0.015); however, mortality and hospital length of stay were not significantly different. Location of injury event (on platform or tracks) showed no difference between the severity of injuries, mortality and hospital length of stay. CONCLUSIONS Current study reports comprehensive injury patterns and outcomes of train-associated injuries from a low- and middle-income country (LMIC). Apart from the mortality, there is a high incidence of permanent disabilities from extremity amputations. No significant difference was noted in the severity and outcomes among patients injured on or off train platforms, emphasizing the need for comprehensive safety measures including enforcement and promoting safe behavior not only on locations like train tracks but equally at platforms.
Collapse
Affiliation(s)
- Dinesh Kumar Bagaria
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niladri Banerjee
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Amit Gupta
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Subodh Kumar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Biplab Mishra
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Narendra Choudhary
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Kumar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Pratyusha Priyadarshini
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Sagar
- Division of Trauma Surgery and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Dept. of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
6
|
Schneble CA, Raymond J, Loder RT. The Demographics of Non-motor Vehicle Associated Railway Injuries Seen at Trauma Centers in the United States 2007 - 2014. Cureus 2019; 11:e5974. [PMID: 31803556 PMCID: PMC6874290 DOI: 10.7759/cureus.5974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction The majority of railway injury studies are limited by small sample size, restricted to a small geographical distribution, or located outside the United States (US). The aim of our study was to assess the demographic patterns associated with non-motor vehicle railway injuries in the US using a national trauma center database. Materials and Methods Data from the National Trauma Data Bank data from 2007 - 2014 were used; 3,506 patients were identified. For all statistical analyses, a p-value < 0.05 was considered significant. Results The patients were 81% male with an average age of 38.6 + 17.1 years and an Injury Severity Score (ISS) of 16.8 + 13.8. Males compared to females were younger (37.7 vs 42.5 years, p = 0.000002), had greater length of stays (12.7 vs 9.8 days, p = 0.000006), and higher ISS scores (17.1 vs 15.4, p = 0.0007). The geographic distribution within the US was most common in the South (32.0%) and least in the Northeast (18.9%). The racial composition was 67.5% White, 19.1% Black, 11.5% Hispanic/Latino, and 1.9% others. The most common mechanisms of injury were hitting/colliding with rolling stock (38.6%), followed by a fall in or from a train (19.5%), and collision with an object (13.5%). The majority of patients were pedestrians or passengers (68.5%); employees accounted for 12.5%. Although the majority were pedestrian/passengers for all regions, the Midwest had a greater proportion of employees (22.0%) compared to the other regions (7.8% to 12.2%) (p < 10-6), and thus injuries were more commonly work-related (24.6% vs 6.7% - 13.7%, p < 10-6). Work-related injuries were less severe (ISS 11.2 vs 17.3 - p < 10-6) and more commonly occurred due to a fall (32.8% vs 17.9%, p < 10-6). Alcohol and/or drug involvement was present in 40.7% and was less in those with work-related injuries (2.2%). Overall mortality was 6.4% and was less in those having a work-related injury (2.0 vs 6.6% p = 0.000004). Conclusion For non-motor vehicle USA railway injuries, the average age was 38.5 years; 80.6% were male. The injuries were least common in the Northeast and most common in the South. Racial distribution mirrored that of the US population. Alcohol involvement was present in 29%, lower than in previous studies. Mortality was 6.4%, also lower than previously reported.
Collapse
Affiliation(s)
- Christopher A Schneble
- Orthopaedic Surgery, Yale University School of Medicine/Yale New Haven Hospital, New Haven, USA
| | - Jodi Raymond
- Pediatric Surgery, Riley Hospital for Children, Indianapolis, USA
| | - Randall T Loder
- Orthopaedic Surgery, Riley Hospital for Children, Indianapolis, USA
| |
Collapse
|
7
|
Byerly S, Inaba K, Biswas S, Cheng V, Cho J, Wang E, Strumwasser A, Matsushima K, Demetriades D. Hit by a Train: Injury Burden and Clinical Outcomes. J Emerg Med 2019; 57:6-12. [PMID: 31078347 DOI: 10.1016/j.jemermed.2019.03.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 03/17/2019] [Accepted: 03/30/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Few data exist regarding the train vs. pedestrian (TVP) injury burden and outcomes. OBJECTIVE This study aimed to examine the epidemiology and outcomes associated with TVP injuries. METHODS This is a retrospective National Trauma Databank study (January 2007 to July 2012) including trauma patients sustaining TVP injury. Demographics, injury data, interventions, and outcomes were abstracted. Patients injured by a train were compared to patients who sustained an automobile vs. pedestrian (AVP) injury. RESULTS Of the 152,631 patients struck by ground transportation during the study time frame, 1863 (1.2%) were TVP. Median TVP age was 38 years (interquartile range [IQR] 24-50 years), 81.6% were male, median Injury Severity Score (ISS) was 13 (IQR 6-24). TVP patients were more severely injured (ISS 13 vs. 9; p < 0.001) and required more proximal amputations (13.4% vs. 0.2%; p < 0.001) and cavitary operations (18.2% vs. 2.8%; p < 0.001). TVP patients had higher rates of intensive care unit admission, mechanical ventilation and transfusion, longer length of stay, and higher in-hospital mortality. On multivariable logistical regression, TVP was an independent predictor for higher injury burden, ISS ≥25 (adjusted odds ratio [AOR] 1.650), immediate operative need (AOR 7.535), and complications (AOR 1.317). CONCLUSIONS TVP is associated with a significant injury burden. These patients have a significantly higher need for immediate operation and more complicated hospital course.
Collapse
Affiliation(s)
- Saskya Byerly
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Kenji Inaba
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Subarna Biswas
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Vince Cheng
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Jayun Cho
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Eugene Wang
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Aaron Strumwasser
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Kazuhide Matsushima
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| | - Demetrios Demetriades
- Division of Trauma and Critical Care, University of Southern California, Los Angeles, California
| |
Collapse
|
8
|
Ceccato V, Uittenbogaard A. Suicides in commuting railway systems: The case of Stockholm county, Sweden. J Affect Disord 2016; 198:206-21. [PMID: 27018939 DOI: 10.1016/j.jad.2016.02.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 01/29/2016] [Accepted: 02/25/2016] [Indexed: 11/17/2022]
Abstract
The objective of this study is to understand the spatial and temporal dynamics of suicides in commuting railway environments. Data on suicides in Stockholm commuting railway from 2006 to 2013 was analysed. The study sets out to identify significant clusters in suicides then evaluate whether commuting railway environments affect variations in suicide rates. Fieldwork inspection, spatial cluster techniques (NNHC and Getis-Ord statistics) and regression models underlie the methodology of study. Findings show no seasonality was observed in suicide cases, but winter months concentrate a larger share of events. Suicides do not occur evenly throughout the day but tend to take place more often in weekdays. Modelling findings shows that suicide rates increase with speed trains and decrease where barriers along tracks are installed. Although high speed trains are still a motive of concern for suicide prevention, findings call for a whole railway-approach to safety - one that extends maintenance beyond the platforms and stations' vicinities.
Collapse
Affiliation(s)
- Vania Ceccato
- Housing and Safety Research Group, Department of Urban Planning and Environment, School of Architecture and the Built Environment (ABE), Royal Institute of Technology (KTH), Drottning Kristinasväg, 30 10044 Stockholm, Sweden.
| | - Adriaan Uittenbogaard
- Housing and Safety Research Group, Department of Urban Planning and Environment, School of Architecture and the Built Environment (ABE), Royal Institute of Technology (KTH), Drottning Kristinasväg, 30 10044 Stockholm, Sweden
| |
Collapse
|