European Journal of Cardiovascular Medicine

Road traffic injuries (RTIs) constitute a major public health challenge worldwide and are among the leading causes of morbidity and mortality, particularly in low- and middle-income countries. According to the World Health Organization (WHO), approximately 1.19 million people die each year due to road traffic crashes, and an additional 20-50 million individuals suffer non-fatal injuries, many of which result in long-term disability ^[1]. South-East Asia contributes a substantial proportion of this global burden, with India accounting for a significant share due to rapid urbanization, increasing motorization, inadequate road safety infrastructure, and variable enforcement of traffic regulations.

In India, road traffic injuries represent one of the leading causes of death among individuals aged 15-49 years, contributing significantly to premature mortality and economic loss. The burden of RTIs is not limited to mortality alone but extends to prolonged hospitalizations, disability, loss of productivity, and psychological trauma to victims and families. Emergency departments of tertiary care hospitals often serve as the primary point of care for victims of road traffic accidents, making them critical sites for understanding injury patterns and associated determinants ^[2].

The pattern of road traffic injuries is influenced by multiple factors including demographic characteristics, type of road user, mode of transport, use of protective devices, alcohol consumption, environmental conditions, and timing of the accident. Studies have shown that two-wheeler users, pedestrians, and young adult males are particularly vulnerable groups ^[3]. Furthermore, head injuries, fractures, and polytrauma are common consequences, often necessitating urgent surgical intervention and intensive care management.

Understanding the epidemiological pattern and injury characteristics among road traffic accident victims is essential for designing targeted preventive strategies, improving trauma care systems, and formulating evidence-based road safety policies. Hospital-based cross-sectional studies provide valuable insights into injury profiles, risk factors, and immediate outcomes, which can guide both clinical management and public health interventions ^[4].

Aim

To study the pattern of road traffic injuries among victims attending the emergency department of a tertiary care hospital.

Objectives                

1. To describe the socio-demographic profile and injury characteristics of road traffic accident victims presenting to the emergency department.
2. To assess the distribution of road traffic injuries based on type of road user, mechanism of injury, and anatomical pattern of trauma.
3. To evaluate the association between injury patterns and selected risk factors such as helmet use, alcohol intake, and time of accident.

Source of Data Data were collected from patients presenting with road traffic injuries to the Emergency Department of a tertiary care teaching hospital. Study Design A hospital-based cross-sectional observational study. Study Location The study was conducted in the Emergency Department of a tertiary care hospital catering to urban and semi-urban populations. Study Duration The study was conducted over a period of 12 months. Sample Size A total of 120 patients with road traffic injuries were included in the study. Inclusion Criteria • All patients of either gender presenting to the emergency department with a history of road traffic accident. • Patients aged ≥18 years. • Patients or legally authorized representatives providing informed consent. Exclusion Criteria • Patients brought dead to the emergency department. • Victims with incomplete clinical records. • Patients who left against medical advice before complete evaluation. Procedure and Methodology All eligible patients presenting to the emergency department following a road traffic accident were enrolled consecutively. After initial stabilization and emergency management as per institutional protocols, detailed information was collected using a predesigned and pretested proforma. Data included socio-demographic details, type of road user, mechanism of injury, use of safety measures (helmet/seatbelt), time and place of accident, alcohol consumption, and mode of transport to the hospital. Clinical assessment included general examination, systemic examination, and injury assessment based on anatomical regions involved. Relevant investigations such as radiographs, CT scans, and laboratory tests were reviewed to document injury patterns. The severity of injuries was assessed using clinical judgment and imaging findings. Sample Processing All collected data were verified for completeness and accuracy before entry into a structured database. Confidentiality of patient information was strictly maintained. Statistical Methods Data were entered into Microsoft Excel and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Descriptive statistics were expressed as frequencies, percentages, mean, and standard deviation. Associations between categorical variables were assessed using the Chi-square test or Fisher’s exact test as appropriate. A p-value of <0.05 was considered statistically significant. Data Collection Data were collected prospectively through patient interviews, clinical examination, medical records, and investigation reports using a standardized case record form.

Table 1 depicts the pattern of road traffic injuries among 120 victims presenting to the emergency department. The mean age of the study population was 34.7 ± 12.8 years, with admitted patients being significantly older than those discharged (38.1 ± 13.4 vs 32.0 ± 12.0 years; p = 0.011). Male predominance was observed, accounting for 65.8% of cases, and males were significantly more likely to require admission compared to females (75.5% vs 58.2%; OR = 2.21, p = 0.048).

Urban residents constituted 60.8% of the study population, with a significantly higher proportion requiring admission compared to rural residents (71.7% vs 52.2%; OR = 2.32, p = 0.030). Alcohol consumption at the time of the accident was reported in 25.8% of cases and showed a strong association with hospital admission (37.7% vs 16.4%; OR = 3.09, p = 0.008). Similarly, accidents occurring during nighttime hours accounted for 38.3% of cases and were significantly associated with higher admission rates (49.1% vs 29.9%; OR = 2.27, p = 0.031).

Table 1: Pattern of Road Traffic Injuries among Victims Attending the Emergency Department (N = 120)

Table 2: Socio-Demographic Profile and Injury Characteristics of Road Traffic Accident Victims (N = 120)

Table 2 outlines the socio-demographic characteristics and injury-related factors among road traffic accident victims. Individuals aged ≥40 years constituted 36.7% of cases, with a significantly higher proportion requiring hospital admission compared to younger individuals (50.9% vs 25.4%; OR = 3.05, p = 0.004). Male victims again predominated and were more likely to be admitted (75.5% vs 58.2%; OR = 2.21, p = 0.048).

Low educational status (primary education or below) was observed in 34.2% of patients and was significantly associated with increased hospitalization (45.3% vs 25.4%; OR = 2.44, p = 0.022). Non-use of protective devices such as helmets or seatbelts was reported in 56.7% of victims and demonstrated a strong association with admission (71.7% vs 44.8%; OR = 3.10, p = 0.004). Additionally, multiple injuries were present in 40.8% of patients and were significantly more frequent among those admitted (58.5% vs 26.9%; OR = 3.80, p < 0.001).

Table 3 illustrates the distribution of injuries based on road user category, mechanism of injury, and anatomical involvement. Two-wheeler riders constituted the largest group (43.3%) and were significantly more likely to require hospital admission compared to other road users (56.6% vs 32.8%; OR = 2.67, p = 0.009). Pedestrians accounted for 24.2% of cases; however, their association with admission was not statistically significant (p = 0.337).

High-velocity collisions were the most common mechanism of injury (39.2%) and were strongly associated with hospital admission (54.7% vs 26.9%; OR = 3.23, p = 0.002). In contrast, skid or fall-related injuries were less frequently associated with admission and did not demonstrate statistical significance (p = 0.315).

Table 3: Distribution of Road Traffic Injuries Based on Road User Type, Mechanism, and Anatomical Pattern (N = 120)

Regarding anatomical injury patterns, head injuries were the most prevalent (42.5%) and showed a strong association with hospital admission (60.4% vs 28.4%; OR = 3.87, p < 0.001). Lower limb injuries accounted for 30.8% of cases but were not significantly associated with admission status (p = 0.351). These findings highlight head injuries and high-velocity mechanisms as key determinants of injury severity and hospitalization among road traffic accident victims.

Pattern of Road Traffic Injuries and Associated Risk Factors: The present study evaluated the pattern of road traffic injuries (RTIs) among 120 victims presenting to a tertiary care emergency department and identified several demographic and behavioral determinants influencing injury severity and hospitalization. The mean age of victims was 34.7 ± 12.8 years, with significantly higher age observed among admitted patients compared to those discharged (38.1 vs 32.0 years, p = 0.011). This finding aligns with studies by Babalola OR et al. (2015)^[5], who reported that economically productive age groups are disproportionately affected due to increased exposure to road traffic environments and occupational travel demands. The higher admission rates among older individuals may reflect reduced physiological resilience and a greater burden of comorbidities.

Male predominance (65.8%) observed in this study is consistent with global and Indian literature, where males account for 70-80% of RTI victims due to greater risk-taking behaviors and higher exposure to road traffic. The significantly higher odds of admission among males (OR = 2.21, p = 0.048) corroborate findings by Aghajani MH et al. (2017)^[6], who reported greater injury severity among male victims due to speeding, alcohol use, and low compliance with protective measures.

Urban residence was significantly associated with increased hospitalization in the present study (OR = 2.32, p = 0.030). This may be attributed to higher vehicular density, congestion, and high-speed traffic corridors in urban areas. Similar observations were made by Baru A et al. (2019)^[7], who reported a higher burden of severe injuries in urban settings compared to rural regions due to traffic volume and complex road environments.

Alcohol consumption at the time of injury emerged as a strong predictor of hospital admission (OR = 3.09, p = 0.008). This finding is consistent with multiple Indian and global studies demonstrating a strong association between alcohol intoxication and severe RTIs, impaired reaction time, and risk-taking behavior. Night-time accidents were also significantly associated with admission, reflecting poor visibility, fatigue, and increased alcohol consumption during late hours.

Socio-Demographic Factors and Injury Severity

Analysis of socio-demographic characteristics revealed that individuals aged ≥40 years had significantly higher odds of hospitalization (OR = 3.05, p = 0.004). This is comparable to findings by Hokkam E et al. (2015)^[8], who reported that advancing age is associated with greater injury severity and poorer physiological reserve. Low educational status was another significant determinant, with victims having primary education or less showing higher admission rates (OR = 2.44, p = 0.022), highlighting the role of health literacy and safety awareness in injury prevention.

Non-use of protective devices such as helmets or seatbelts was highly prevalent (56.7%) and strongly associated with hospital admission (OR = 3.10, p = 0.004). Similar trends have been reported in Indian studies where lack of helmet use increased the risk of severe head injuries and mortality by three to four times. Furthermore, multiple injuries were observed in 40.8% of cases and were significantly associated with admission (OR = 3.80, p < 0.001), indicating higher trauma burden and need for inpatient management.

Road User Type, Mechanism, and Anatomical Pattern of Injury: Two-wheeler riders constituted the largest group of victims (43.3%) and were significantly more likely to require hospital admission (OR = 2.67, p = 0.009). This finding is consistent with national data indicating two-wheelers as the most vulnerable road users in India due to minimal physical protection and high exposure risk. Pedestrian injuries, although common, were not significantly associated with hospital admission in the present study, possibly due to lower injury severity or better prehospital triage. Bashah DT et al. (2015)^[9] & Getachew S et al. (2016)^[10]

High-velocity collisions emerged as a critical determinant of severe injury (OR = 3.23, p = 0.002), echoing findings from WHO and Indian trauma registries that identify speed as a key modifiable risk factor for road traffic mortality. In contrast, skid or fall-related injuries showed no significant association with admission, suggesting relatively lower trauma severity. Negussie A et al. (2018)^[11]

Head injuries were the most frequent anatomical injury (42.5%) and showed a strong association with hospitalization (OR = 3.87, p < 0.001). This aligns with multiple studies indicating head injury as the leading cause of mortality and morbidity among RTI victims, particularly in the absence of helmet use. Lower limb injuries, although common, were not significantly associated with admission, reflecting their comparatively lower life-threatening potential. Al-Zamanan MY et al. (2018)^[12]

The present cross-sectional study highlights the significant burden of road traffic injuries among victims attending the emergency department of a tertiary care hospital. The findings reveal that young and middle-aged males constitute the most affected population, with a higher likelihood of hospital admission among older individuals, males, urban residents, and those involved in alcohol-related or nighttime accidents. Two-wheeler riders emerged as the most vulnerable road users, and high-velocity collisions were identified as a major contributor to severe injuries requiring hospitalization. Head injuries were the most common and clinically significant anatomical injury, emphasizing the critical role of helmet use and early trauma care. Socio-demographic factors such as lower educational status and non-use of protective devices were strongly associated with increased injury severity, highlighting the role of behavioral and awareness-related determinants. The study underscores the need for strengthened enforcement of traffic safety laws, promotion of protective gear usage, public education campaigns, and improved urban traffic management. Additionally, the findings support the need for enhanced emergency response systems and trauma care infrastructure to reduce morbidity and prevent avoidable mortality. Overall, the study provides valuable epidemiological evidence to inform road safety interventions and policy formulation aimed at reducing the burden of road traffic injuries. LIMITATIONS OF THE STUDY 1. The cross-sectional study design limits the ability to establish causal relationships between risk factors and injury outcomes. 2. Being a single-center hospital-based study, the findings may not be generalizable to the wider population or rural settings. 3. Data on alcohol consumption and helmet or seatbelt use were partly based on self-reporting or attendant history, which may introduce recall or reporting bias. 4. Long-term outcomes, disability status, and post-discharge mortality were not assessed. 5. Severity scoring systems such as ISS or GCS were not uniformly applied, which could have strengthened injury severity analysis. 6. Environmental and road-related factors such as road conditions, lighting, and traffic density were not evaluated in detail.

1. Chichom-Mefire A, Palle-Ngunde J, Fokam PG, Mokom-Awa A, Njock R, Ngowe-Ngowe M. Injury patterns in road traffic victims comparing road user categories: Analysis of 811 consecutive cases in the emergency department of a level I institution in a low-income country. International Journal of Surgery Open. 2018 Jan 1;10:30-6.
2. Seid M, Azazh A, Enquselassie F, Yisma E. Injury characteristics and outcome of road traffic accident among victims at Adult Emergency Department of Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: a prospective hospital based study. BMC emergency medicine. 2015 May 20;15(1):10.
3. Gebresenbet RF, Aliyu AD. Injury severity level and associated factors among road traffic accident victims attending emergency department of Tirunesh Beijing Hospital, Addis Ababa, Ethiopia: a cross sectional hospital-based study. PLoS One. 2019 Sep 26;14(9):e0222793.
4. Misra P, Majumdar A, Misra MC, Kant S, Gupta SK, Gupta A, Kumar S. Epidemiological study of patients of road traffic injuries attending emergency department of a trauma center in New Delhi. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2017 Oct;21(10):678.
5. Babalola OR, Oluwadiya K, Vrgoč G, Akpati U, Sindik J, Čoklo M, Marinović M, Bakota B. Pattern of emergency room mortality among road traffic crash victims. Injury. 2015 Nov 1;46:S21-3.
6. Aghajani MH, Haddadi M, Saadat S. Epidemiological pattern of injuries in Iran; a nationwide review of seven million emergency department admissions. Emergency. 2017 Jan 8;5(1):e10.
7. Baru A, Azazh A, Beza L. Injury severity levels and associated factors among road traffic collision victims referred to emergency departments of selected public hospitals in Addis Ababa, Ethiopia: the study based on the Haddon matrix. BMC emergency medicine. 2019 Jan 3;19(1):2.
8. Hokkam E, Gonna A, Zakaria O, El-Shemally A. Trauma patterns in patients attending the emergency department of Jazan General Hospital, Saudi Arabia. World journal of emergency medicine. 2015;6(1):48.
9. Bashah DT, Dachew BA, Tiruneh BT. Prevalence of injury and associated factors among patients visiting the Emergency Departments of Amhara Regional State Referral Hospitals, Ethiopia: a cross-sectional study. Bmc emergency medicine. 2015 Aug 25;15(1):20.
10. Getachew S, Ali E, Tayler-Smith K, Hedt-Gauthier B, Silkondez W, Abebe D, Deressa W, Enquessilase F, Edwards JK. The burden of road traffic injuries in an emergency department in Addis Ababa, Ethiopia. Public health action. 2016 Jun 21;6(2):66-71.
11. Negussie A, Getie A, Manaye E, Tekle T. Prevalence and outcome of injury in patients visiting the emergency Department of Yirgalem General Hospital, Southern Ethiopia. BMC emergency medicine. 2018 May 22;18(1):14.
12. Al-Zamanan MY, Al-Yami AS, Al-Najrani AA, Al-Asmari MY, Manaa AA, Al-Qahtani AM, Shalayel MH, Elbashir AM, Alsareii SA. Injury pattern among road traffic accidents’ victims in Najran City, Saudi Arabia. International Journal of Clinical Medicine. 2018 Apr 27;9(04):270.