| Abstract | Uvod: Kraniocerebralne ozljede koje obuhvaćaju prijelome lubanje i ozljede mozga su sve češće u razvijenom svijetu, prvenstveno radi raširene uporabe motornih vozila. Zbog svoje ozbiljnosti i potencijalno dugotrajnih zdravstvenih posljedica predstavljaju veliki javnozdravstveni izazov, a ujedno su često u fokusu sudskomedicinskih analiza. Iako je mozak dobro zaštićen lubanjom, mehanizmi prijeloma mogu biti složeni i ugroziti život. .Cilj istraživanja je analizirati obdukcijske podatke o kraniocerebralnim ozljedama kao uzroku smrti preminulih nasilnom smrću u Dubrovačko-neretvanskoj županiji.
Metodologija: obdukcijski zapisnici susljedno preminulih zbog kraniocerebralne ozljede od 01. siječnja 2018. do 31. prosinca 2022. izuzeti su iz arhive Odjela za patologiju Opće bolnice Dubrovnik. Iz zapisnika su prikupljeni podaci o spolu, životnoj dobi, opisu ozljede (unutarnja ili vanjska), zbiru ozljeda (izolirana ili u sklopu višestrukih ozljeda), mehanizmu nastanka ozljede (pad, udarac, prometna nesreća i drugo), vrsti nasilne smrti (samoubojstvo, ubojstvo, nesretan slučaj) i obdukcijskom nalazu u području glave. U slučaju prometne nesreće, posebno su analizirani način stradavanja (nalet vozila, motocikl, u vozilu) te vrijeme i mjesto kad je nastupila smrt (na mjestu nesreće, u transportu do bolnice ili u bolnici).
Rezultati: U petogodišnjem razdoblju izvršene su 72 obdukcije preminulih s kranocerebralnom ozljedom kao uzrokom smrti. Nesretni slučaj u koji spadaju prometne traume je značajno češći od ostalih vrsta nasilne smrti (P<0,001). Ukupni broj i broj povezan s prometnom traumom bio je značajno manji 2021. godine nego drugih godina (P=0,022, odnosno P<0,01). Prosječna dob svih 72 preminulih bila je 50 godina, mod 40 godine, a 35 preminulih zbog prometne traume 39 godina, mod 40 godina. Sudskomedicinska obdukcija urađena je značajno ĉešće od drugih tipova obdukcije, ukupno i u preminulih zbog prometne traume (svi P<0,001). Prometna trauma je najčešći mehanizam ozljede (P<0,001). U skupini preminulih zbog kraniocerebralne lezije u prometu veća je učestalost zatvorene i izolirane kraniocerebralne ozljede (svi P<0,001). Najviše poginulih bili su vozači automobila, 13 (36,11%) i motora (16,67%), a najčešća smrt na licu mjesta ( P<0,001).
Zaključak: Značajno manji broj obduciranih zbog kraniocerebralnih ozljeda u 2021. godini vjerojatno je povezan s protu-epidemijskim mjerama tijekom COVID-19 pandemije koje su ograničile kretanje stanovništva i promet. Razlika po spolu vjerojatno je povezana s tradicionalno različitim obrascima rizičnog ponašanja. U Dubrovaĉko-neretvanskoj županiji
su kraniocerebralne ozljede značajan uzrok smrti, a najčešći mehanizam ozljeđivanja prometna nesreća. Rezultati naglašavaju važnost prevencije ozljeda i poboljšanja sigurnosnih mjera, posebno u prometu. |
| Abstract (english) | Forensic aspects of craniocerebral injuries determined by autopsy diagnosis in Dubrovnik General Hospital
Introduction: Craniocerebral injuries, which include skull fractures and brain injuries, are increasingly common in the developed world, primarily due to the widespread use of motor vehicles. Due to their seriousness and potentially long-term health consequences, they are a major public health challenge, and at the same time, they are often the focus of forensic analyses. Although the brain is well protected by the skull, fracture mechanisms can be complex and life-threatening. The aim of the research is to analyze post-mortem data on craniocerebral injuries as the cause of death of violent deaths in Dubrovnik-Neretva County.
Methodology: autopsy records of consecutive deaths due to craniocerebral injury from January 1, 2018 to December 31, 2022 were extracted from the archives of the Department of Pathology of the Dubrovnik General Hospital. Data were collected from the records on gender, age, description of injuries (internal or external), set of injuries (isolated or as part of multiple injuries), mechanism of injury (fall, blow, traffic accident, etc.), type of violent death (suicide, murede, accident) and autopsy findings in the head. In the case of a traffic accident, the manner of death (a collision with a vehicle, a motorcycle, in a vehicle) and the time and place when death occurred (at the scene of the accident, in transport to the hospital or in the hospital) are analyzed separately.
Results: In a five-year period, 72 autopsies were performed on deceased with craniocerebral injury as the cause of death. Accidents involving traffic trauma were significantly more frequent than other types of violent death (P<0.001). The total number and the number related to traffic trauma were significantly lower in 2021 than in other years (p=0.022, respectively P<0.01). The average age of all 72 deceased was 50 years, mode 40 years, and 35e who died due to traffic trauma 39 years, mode 40 years. Forensic autopsy was performed significantly more often than other types of autopsy, both in total and in deceased due to traffic trauma (all P<0.001). Traffic trauma was the most common mechanism of injury (P<0.001). In the group of those who died due to a craniocerebral lesion in traffic, the frequency of closed and isolated craniocerebral injury was higher (all P<0.001). The majority of deceased were car drivers, 13 (36.11%) and motorcycle drivers (16.67%), the most often dead on the spot (P<0.001).
Conclusion: The significantly lower number of deceased due to craniocerebral injuries in 2021 was probably related to anti-epidemic measures during the COVID-19 pandemic, which limited the movement of the population and traffic. The sex difference was related to traditionally different patterns of risky behavior. In Dubrovnik-Neretva County, craniocerebral injuries are a significant cause of death, and the most common mechanism of injury in a traffic accident. The results emphasize the importance of injury prevention and improvement of safety measures, especially in traffic. |
