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Road Traffic Injury Questionnaire

This document appears to be a questionnaire from Khyber Medical University in Pakistan regarding injuries from road traffic accidents. The questionnaire collects information such as the subject's sex, age, occupation, type of road user, vehicle position, whether vehicles collided, safety equipment usage, types of injuries sustained, body parts injured, and patient condition. The purpose is to gather injury data from road accidents.

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ms khan
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272 views2 pages

Road Traffic Injury Questionnaire

This document appears to be a questionnaire from Khyber Medical University in Pakistan regarding injuries from road traffic accidents. The questionnaire collects information such as the subject's sex, age, occupation, type of road user, vehicle position, whether vehicles collided, safety equipment usage, types of injuries sustained, body parts injured, and patient condition. The purpose is to gather injury data from road accidents.

Uploaded by

ms khan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

KHYBER MEDICAL UNIVERSITY

Graduate study committee


KMU-IPMS,
KHYBER PAKHTUNKHWA, PESHAWAR, PAKISTAN

INJURY QUESTIONNAIRE
ROAD TRAFFIC ACCIDENTS
S.No:_________
Sex:
 Male  Female

Age in years:
 <15
 35–44
 15–24
 45–64
 25–34
 ≥65

Occupation:___________________

Which type of road user?


 Passengers  Drivers

 Motorcyclists  Pedal cyclist

 Pedestrians

What was your position in the car?


 Driver

 Passenger: If passenger, were you sitting in

 Front  Right Rear  Left Rear

Did your vehicle strike another vehicle?


 Yes  No

Was your vehicle struck by another vehicle?


 Yes  No

Were you wearing a seat belt?


 Yes  No

Did your vehicle have headrests?


 Yes  No

airbags?
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KHYBER MEDICAL UNIVERSITY
Graduate study committee
KMU-IPMS,
KHYBER PAKHTUNKHWA, PESHAWAR, PAKISTAN

 Yes  No

What type of vehicle hit you? _______________________________

Did you have any cuts?


 Yes  No

Bruises?
 Yes  No

Abrasions
 Yes  No

Fractures
 Yes  No

Site of fracture?

 Skull and maxillofacial  Rib fracture

 Upper limb fracture  Spinal fracture

 Lower limb fracture  Pelvic fracture

Which part of the body got injured?


 Extremities  Head /neck

 Lower limb  Chest

 Upper limb  Abdomen

 Maxillofacial  Others

Patients condition on arrival or discharge?


 Survived without long term disability  Died on discharge

 Survived with long term disability

 Died on arrival

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