European Journal of Cardiovascular Medicine

Every year more than 10 million people are affected by traumatic brain injuries (TBIs). Despite efforts being made to improve TBI care, it remains a public health problem, continuing to cause high mortality and morbidity in a young population. The World Health Organization (WHO) considers TBI to be one of the most pressing and underrecognized areas in public health problems, with predictions that by 2020, it will be the third highest cause of death and disability. It has been shown that in low-middle income countries in the past 17 years, violence and road traffic accidents (RTAs) have been the main causes of TBI and have associated high mortality. [1]There is a clear regional variation in the disease impact; not only low- and middle-income areas do have a higher incidence of TBI but also are associated with greater morbimortality. A reason for this may be the lower level of acute health care provision in these areas, lack of access to existing health care systems, and disjointed or non-existent preventative measures. Although violence and industrial accidents account for a significant proportion of TBI worldwide, by far the greatest contributor is RTAs, which estimated 60% of the total TBI burden. Traffic accidents make up 2.5% of total deaths worldwide, and the WHO predicts that by 2030, RTA will become the seventh leading cause of death, with an increase from 2.5% in 2015 to 2.6% in 2030 of total world deaths. There is a clear regional variation in line with economic prosperity. Despite high-income countries having 46% of the total vehicles registered worldwide, they make up 10% of RTA deaths. Latin America is a region particularly in need of study. Despite knowing overall mortality from RTA in this area and that TBI is a common sequela of RTA, there are few studies on the impact of RTA on TBI in the Latin American region. [2] Without these data, it is hard to know the extent of the problem, and to direct resources toward the acute care and rehabilitation of TBI victims. Although some valuable research has been done in this area, an accurate overall picture of the problem is hindered by small sample sizes, the heterogeneity of the data, and the lack of focus on epidemiology and etiology. To determine the Incidence of TBI following RTAs in the rural population served by PCS Govt Medical College and Hospital. To identify the causes and risk factors associated with TBI following RTAs in the rural population. To assess the outcomes of TBI following RTAs in terms of mortality, morbidity, and disability.

Study Design: Prospective observational study

Place of Study: PCS Govt Medical College and Hospital, Arambagh, Hooghly, West Bengal.

Period of Study: 1 year (1st August 2024to 31st July 2025)

Study Population: The study population included 216 patients with traumatic brain injury (TBI) following road traffic accidents, admitted to PCS Government Medical College and Hospital over a 12-month period. All age groups and both sexes were included. Patients with TBI from non-traffic causes or incomplete data were excluded. Each patient was evaluated for injury severity, clinical features, and outcome.

Sample Size: 216 Traumatic brain injuries patients

Inclusion Criteria

• Patients aged 18 years and above
• Admitted to PCS Govt Medical College and Hospital following an RTA
• Diagnosed with TBI based on clinical examination and imaging studies (CT/MRI)

Exclusion Criteria

• Patients with incomplete medical records
• Patients who died before hospital admission
• Patients with pre-existing neurological conditions

Study Tools:

• Structured questionnaire to collect demographic and clinical data
• Glasgow Coma Scale (GCS) to assess the severity of TBI
• Modified Rankin Scale (mRS) to assess functional outcome

Study Variables

• Demographic variables: Age, sex, residence (rural/urban).
• Injury-related variables: Type of road traffic accident (two-wheeler, four-wheeler, pedestrian, etc.), use of safety gear (e.g., helmet).
• Clinical variables: Glasgow Coma Scale (GCS) score, vital signs at admission, associated injuries.
• Radiological findings: Type and extent of brain injury on CT scan (e.g., contusion, hemorrhage, skull fracture).

Statistical Analysis: -

For statistical analysis, data were initially entered into a Microsoft Excel spreadsheet and then analysed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism (version 5). Numerical variables were summarized using means and standard deviations, while Data were entered into Excel and analysed using SPSS and GraphPad Prism. Numerical variables were summarized using means and standard deviations, while categorical variables were described with counts and percentages. Two-sample t-tests were used to compare independent groups, while paired t-tests accounted for correlations in paired data. Chi-square tests (including Fisher’s exact test for small sample sizes) were used for categorical data comparisons. P-values ≤ 0.05 were considered statistically significant.

Table 1: Characteristics of Severity and Outcome in Patients with Traumatic Brain Injury by Mechanism of Injury (n = 216)

Table 2: Distribution of Age, Gender, Country of Origin, and Economic Level of Patients with Traumatic Brain Injury in different injury groups.

Table 3: Severity and Outcome in different groups of Traumatic Brain Injury Patients caused by different Mechanism

Figure 1: Distribution of Patients with Traumatic Brain Injury by Mechanism of Injury

In our study involving 216 patients with traumatic brain injury (TBI), the most common mechanism of injury was two-wheeler accidents (108 patients, 50.0%), followed by four- wheeler accidents (48 patients, 22.2%), pedestrian hits (36 patients, 16.7%), and other causes such as falls or animal hits (24 patients, 11.1%). Mild TBI was seen in 118 patients (54.6%), moderate in 65 patients (30.1%), and severe in 33 patients (15.3%), with a statistically significant association between mechanism and severity (p = 0.041 for mild, p

= 0.035 for severe TBI). Surgery was required in 76 patients (35.2%), ICU admission was needed for 94 patients (43.5%), mortality occurred in 14 patients (6.5%), and neurological deficits were observed in 31 patients (14.4%). Significant associations were noted between the mechanism of injury and the requirement for surgery (p = 0.018) and ICU admission (p = 0.007), whereas associations with mortality (p = 0.134) and neurological deficits (p = 0.058) did not reach statistical significance.

The overall mean age was 36.9 ± 13.2 years, with significant variation across mechanisms (p = 0.002); patients injured in two-wheeler accidents were the youngest (31.8 ± 11.2 years), while those in the “others” group were the older (45.1 ± 12.8 years). The majority of patients were male (162, 75.0%), with no significant gender difference across groups (p = 0.981).

In our study comprising 216 patients with traumatic brain injury (TBI), two-wheeler accidents accounted for the majority (108 patients, 50.0%), followed by four-wheeler accidents (48 patients, 22.2%), pedestrian hits (36 patients, 16.7%), and other causes such as falls or animal-related injuries (24 patients, 11.1%). Mild TBI (GCS 13–15) was observed in 118 patients (54.6%), moderate TBI (GCS 9–12) in 65 patients (30.1%), and severe TBI (GCS ≤8) in 33 patients (15.3%). Among two-wheeler accident victims, 60 had mild TBI (55.6%), 30 had moderate TBI (27.8%), and 18 had severe TBI (16.6%). In the four-wheeler group, 24 had mild TBI (50.0%), 16 moderate (33.3%), and 8 severe (16.7%). Pedestrian hit cases included 18 mild (50.0%), 11 moderate (30.6%), and 7 severe (19.4%) TBIs, while in the ‘others’ group, 16 had mild (66.7%) and 8 had moderate (33.3%) TBI with no severe cases. A statistically significant association was found between mechanism of injury and both mild (p = 0.045) and severe TBI (p = 0.031). Full recovery was seen in 144 patients (66.7%), with the highest in the ‘others’ group (20 patients, 83.3%). Neurological deficits were present in 48 patients (22.2%), highest among four-wheeler (14 patients, 29.2%) and pedestrian hit (11 patients, 30.6%) cases, showing a significant association (p = 0.049). Mortality occurred in 14 patients (6.5%), with no statistically significant variation across mechanisms (p = 0.391).

We found that two-wheeler accidents were the most common cause of TBI, involving 108 patients (50.0%), followed by four-wheeler accidents (48, 22.2%). Mild TBI was most frequent (118 patients, 54.6%), with a significant association to mechanism of injury (p = 0.041), while severe TBI (33, 15.3%) also showed significance (p = 0.035). Surgery was required in 76 patients (35.2%) and ICU admission in 94 (43.5%), both significantly related to the injury mechanism (p = 0.018 and p = 0.007, respectively). Mortality (14, 6.5%; p = 0.134) and neurological deficits (31, 14.4%; p = 0.058) were more common in four-wheeler and pedestrian injuries but did not reach statistical significance. Similar patterns were noted in recent studies, such as by Nguyen et al.,(2016) who reported road traffic injuries as the most common cause of TBI globally, with young adult males being the predominant group affected [3]. Dewan et al.(2019) also emphasized the burden of TBI in low- and middle-income countries, particularly due to motor vehicle collisions

[4]. A study by Majdan et al.(2016) identified age, GCS score, and mechanism of injury as strong predictors of mortality and outcome in TBI cases, consistent with our findings [5]. Maas et al. (2017) highlighted the increasing need for ICU admissions and surgical intervention in moderate to severe TBI, particularly from vehicular trauma [6]. Moreover, Yue et al. (2017) reported long-term functional impairments and neurological sequelae following road traffic-related TBIs, reinforcing the importance of injury mechanism in predicting outcome [7].

We showed that two-wheeler accidents were the most common cause of TBI, accounting for 108 patients (50.0%), followed by four-wheeler accidents (48, 22.2%), pedestrian hits (36, 16.7%), and others such as falls or animal hits (24, 11.1%). The overall mean age was 36.9 ±

13.2 years, with a statistically significant difference across mechanisms (p = 0.002); patients injured in two-wheeler accidents were the youngest (31.8 ± 11.2 years), while those in the “others” group were the older (45.1 ± 12.8 years). The majority were male (162, 75.0%) with no significant gender difference across groups (p = 0.981). These findings are consistent with global trends reported by Dewan et al.(2016) and Nguyen et al.,(2016) who noted that road traffic accidents—especially involving young adult males—are the leading contributors to TBI in low- and middle-income countries (LMICs) [4,3].

We found that two-wheeler accidents were the most frequent cause of TBI (108 patients, 50.0%), followed by four-wheeler accidents (48, 22.2%), pedestrian hits (36, 16.7%), and other causes like falls or animal hits (24, 11.1%). Mild TBI (118 patients, 54.6%) was the most common severity level, with a statistically significant association with mechanism of injury (p = 0.045). Severe TBI occurred in 33 patients (15.3%), significantly associated with injury type (p = 0.031). Full recovery was achieved in 144 patients (66.7%), highest in the "others" group (83.3%), though not statistically significant (p = 0.117). Neurological deficits were seen in 48 patients (22.2%), significantly associated with mechanism (p = 0.049), and mortality occurred in 14 patients (6.5%) without significant difference across groups (p = 0.391). These results are consistent with recent global studies. Dewan et al.(2020) noted that road traffic injuries continue to dominate TBI etiology, especially in low- and middle- income countries, with motorized two-wheeler users being highly vulnerable [8]. Chibbaro et al (2020). Highlighted that injury mechanism plays a crucial role in determining severity and outcomes, particularly in younger patients [9]. Ruan et al. (2021) reported that the likelihood of severe TBI and ICU need is significantly linked to the type of accident, with higher risk observed in vehicular trauma [10]. Narayanasamy et al. (2021) emphasized that early surgical intervention and ICU care are critical for improving recovery in moderate to severe TBIs, commonly seen in road traffic cases [11]. Moreover, Capizzi et al. (2022) found that even mild TBIs can result in long-term functional deficits, particularly in injuries sustained during high-impact trauma such as two-wheeler or pedestrian collisions [12].

We concluded that this study shows that one of the major public health concerns in rural areas is traumatic brain injury (TBI) after road traffic accidents (RTAs). The most common cause, which primarily affected younger boys, was two-wheeler accidents. The most common presentation was mild TBI, although four-wheeler and pedestrian collisions were more likely to result in severe TBI and negative outcomes such neurological impairments and death. The mechanism of injury was found to be significantly correlated with the severity of TBI, the requirement for surgery, and the need to be admitted to the intensive care unit.

Certain groups had greater rates of death and disability, but these differences were not statistically significant. In order to lessen the burden of TBI, these findings highlight the necessity of increased road safety, helmet compliance, and emergency trauma care in rural areas.

1. Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC. The impact of traumatic brain injuries: a global perspective. NeuroRehabilitation. 2007 Dec 7;22(5):341-53.
2. Dunne J, Quiñones-Ossa GA, Still EG, Suarez MN, González-Soto JA, Vera DS, Rubiano AM. The epidemiology of traumatic brain injury due to traffic accidents in Latin America: a narrative review. Journal of neurosciences in rural practice. 2020 May 2;11(2):287.
3. Nguyen R, Fiest KM, McChesney J, Kwon CS, Jette N, Frolkis AD, et al. The international incidence of traumatic brain injury: a systematic review and meta- analysis. Can J Neurol Sci. 2016 Nov;43(6):774–85.
4. Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung YC, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2019 Apr;130(4):1080–97.
5. Majdan M, Plancikova D, Brazinova A, Rusnak M, Nieboer D, Feigin V, et Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health. 2016 Oct;1(2):e76–83.
6. Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017 Dec;16(12):987–1048.
7. Yue JK, Vassar MJ, Lingsma HF, Cooper SR, Okonkwo DO, Valadka AB, et al. Outcomes after mild traumatic brain injury: results from the TRACK-TBI study. JAMA Neurol. 2017 Aug;74(8):1045–52.
8. Dewan MC, Baticulon RE, Rattani A, et al. Access to neurotrauma care in low- income and middle-income countries: a global survey. Lancet Neurol. 2020;19(10):860–869.
9. Chibbaro S, Ganau M, Todeschi J, et al. Severe traumatic brain injury management: what’s new in 2020? Curr Neurol Neurosci Rep. 2020;20(12):55.
10. Ruan S, Karsy M, Brock A, et al. Impact of injury mechanisms and patterns on severity and outcome in TBI patients. World Neurosurg. 2021;146:e836–e845.
11. Narayanasamy S, Dash HH, Saini V, et al. Outcomes of traumatic brain injury and predictors of prognosis in patients requiring ICU care in a tertiary centre in India. Indian J Crit Care Med. 2021;25(1):56–61.
12. Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic brain injury: a review of pathophysiology and clinical management. Am J Phys Med Rehabil.