title: Evaluation of nature and extent of injuries during Dahihandi festival.
abstract: BACKGROUND
  Injuries related to the Hindu festival of Dahihandi where a human pyramid is formed and a pot of money kept at a height is broken, celebrated in the state of Maharashtra, have seen a significant rise in the past few years. The human pyramid formed is multi-layered and carries with it a high risk of injury including mortality.
  
  
  OBJECTIVE
  To evaluate the nature, extent and influencing factors of injuries related to Dahihandi festival.
  
  
  METHODS
  We present a retrospective analysis of patients who presented in a tertiary care center with injuries during the Dahihandi festival in the year 2010.
  
  
  METHODS
  124 patients' records were evaluated for timing of injury, height of the Dahihandi pyramid, position of the patient in the multi-layered pyramid, mode of pyramid collapse and mechanism of an injury. A binary regression logistic analysis for risk factors was done at 5% significance level.
  
  
  METHODS
  Univariate and multi-variate binary logistic regression of the risk factors for occurrence of a major or minor injury was done using Minitab™ version 16.0 at 5% significance.
  
  
  RESULTS
  Out of 139 patients presented to the center, 15 were not involved directly in the formation of pyramid, rest 124 were included in the analysis. A majority of the patients were above 15 years of age [110 (83.6%)]. 46 (37.1%) patients suffered major injuries. There were 39 fractures, 3 cases of chest wall trauma with 10 cases of head injuries and 1 death. More than half of the patients [78 (56.1%)] were injured after 1800 hours. 73 (58.9%) injured participants were part of the pyramid constructed to reach the Dahihandi placed at 30 feet or more above the ground. 72 (51.8%) participants were part of the middle layers of the pyramid. Fall of a participant from upstream layers on the body was the main mechanism of injury, and majority [101 (81.5%)] of the patients suffered injury during descent phase of the pyramid.
  
  
  CONCLUSIONS
  There is a considerable risk of serious, life-threatening injuries inherent to human pyramid formation and descent in the Dahihandi festival. Safety guidelines are urgently needed to minimize risk and prevent loss of human life.
authors.affiliation: Department of Orthopaedics, Seth G. S. Medical College and K.E.M. Hospital, Acharya Donde Marg, Parel, Mumbai, Maharashtra, India.
authors.forename: P
authors.initials: P
authors.lastname: Nemade
authors.forename: R
authors.initials: R
authors.lastname: Wade
authors.forename: A R
authors.initials: AR
authors.lastname: Patwardhan
authors.forename: S
authors.initials: S
authors.lastname: Kale
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology; D018596:Hinduism; D006693:Holidays; D006801:Humans; D007194:India / Q000453:epidemiology; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014947:Wounds and Injuries / Q000453:epidemiology*; D055815:Young Adult