Road traffic injuries (RTIs) remain a major global public-health problem, causing substantial mortality, morbidity and long-term disability worldwide. The Global Burden of Disease 2019 estimates show that injuries from road traffic crashes account for a large and persistent fraction of injury-related health loss across age groups, with disproportionate effects on young adults and males [1].

Beyond the direct health impact, RTIs impose a significant macroeconomic burden on societies through lost productivity and increased healthcare costs; global estimates indicate sizable economic losses attributable to road injuries across low- and middle-income countries [2].

In India, RTIs are a leading cause of trauma admissions and medicolegal casework. Two-wheelers constitute a large share of the vehicle fleet and are frequently implicated in crashes; observational and hospital-based studies from Indian settings consistently report predominance of young male victims, a high proportion of two-wheeler involvement, and limb and head injuries as common presentations [3,4].

Two preventable factors consistently associated with worse outcomes are low helmet use among motorcyclists and alcohol-impaired driving. Community and roadside observational studies in Indian cities have documented low prevalence of effective (standard, full-face and properly fastened) helmet use, and hospital-based series report substantial proportions of victims with alcohol involvement at the time of crash [3,4].

From a medicolegal perspective, descriptive autopsy and forensic case series emphasize variable injury patterns according to road-user type (pedestrian, two-wheeler rider, four-wheeler occupant) and highlight the forensic importance of systematically documenting injury distribution, mechanism and contributory factors for both clinical management and medico-legal proceedings [5].

Given these public-health, clinical and medicolegal imperatives, we performed a hospital-based cross-sectional study to characterize the pattern of RTA injuries among medicolegal cases presenting to a tertiary center. The study aimed to describe the sociodemographic profile, road-user categories, mechanisms, nature and anatomical distribution of injuries, severity, use of protective measures and alcohol involvement — data intended to inform prevention, clinical care and medicolegal practice.

MATERIAL AND METHODS

Study Design and Setting: This investigation was designed as a hospital-based, descriptive, cross-sectional study .All medicolegal cases presenting with a documented history RTA during the study period were systematically evaluated.

Study Population: The study population consisted of all individuals brought for medicolegal examination following involvement in an RTA, irrespective of age, sex, or type of road user.

Sample Size: A total of 320 consecutive medicolegal cases fulfilling the inclusion criteria were included. Sample size was determined based on the average annual caseload of RTA cases in the institution and the expected variability in injury patterns.

Inclusion Criteria

• Patients or deceased individuals brought for medicolegal evaluation with a confirmed history of involvement in an RTA.
• Cases with complete medicolegal documentation and injury details.

Exclusion Criteria

• Cases with incomplete records or unclear injury descriptions.
• Patients unwilling to provide consent where required (for living victims).
• Injuries unrelated to RTAs (e.g., assault, fall, industrial accidents).

Data Collection Procedure: Data were collected using a structured proforma that captured-

• Sociodemographic details (age, sex, residence).
• Type of road user (driver, rider, pillion rider, pedestrian, passenger).
• Mechanism of the accident (collision, skidding, fall from vehicle, hit-and-run, etc.).
• Type and nature of injuries including abrasions, lacerations, contusions, fractures, visceral injuries, and head trauma.
• Anatomical distribution of injuries, categorized using standard forensic anatomical regions.
• Protective measures used (e.g., helmet, seatbelt), if documented.
• Alcohol or intoxicant involvement, based on medicolegal records.

Clinical records, emergency department notes, radiological reports, and autopsy findings (for fatal cases) were reviewed whenever available.

Classification of Injuries: Injuries were classified according to-

• Nature: soft-tissue injuries, skeletal injuries, visceral injuries.
• Severity: minor, moderate, or severe, based on standard medicolegal criteria and the requirement of hospitalization.
• Body region: head and neck, thorax, abdomen, upper limbs, lower limbs, and multiple-region involvement.

Statistical Analysis: Data were entered in Microsoft Excel and analyzed using SPSS version 26.0. Descriptive statistics including frequencies, proportions, means, and standard deviations were used to summarize variables. The association between injury patterns and selected sociodemographic or accident-related factors was evaluated using Chi-square test, with a significance threshold of p < 0.05.

RESULTS

A total of 320 medicolegal RTA cases were evaluated. The sociodemographic distribution is presented in Table 1. Young adults constituted the largest proportion of victims, with 40.0% in the 18–30-year age group, followed by 29.4% in the 31–45-year age bracket. Individuals younger than 18 years and those older than 60 years each accounted for 6.9% of cases. Males comprised 74.4% of the study population, while 25.6% were females. Slightly more victims were from urban areas (58.1%) than rural regions (41.9%).

The pattern of involvement in the traffic event and the mechanism of injury is detailed in Table 2. Motorcyclists represented the largest subgroup (44.4%), followed by pedestrians (18.1%) and pillion riders (16.3%). Drivers of four-wheeled vehicles constituted 14.4% of cases, while passengers in public transport formed the smallest category (6.9%). The most frequent mechanism was vehicle-to-vehicle collision (43.1%), followed by skid or fall from a two-wheeler (30.0%). Pedestrian impacts contributed to 16.9% of injuries, whereas vehicle overturning and hit-and-run events accounted for 5.6% and 4.4%, respectively.

The overall pattern and nature of injuries are summarized in Table 3. Abrasions were the most common lesion (66.9%), followed by contusions (55.6%) and lacerations (35.0%). Fractures were noted in 29.4% of cases, while internal organ injuries and crush injuries were documented in 10.0% and 5.6% of individuals, respectively.

The anatomical distribution and severity of injuries are described in Table 4. The lower limbs were most frequently affected (48.8%), followed by the head and neck region (43.1%) and the upper limbs (38.8%). Injuries involving the chest and abdomen were less common, accounting for 14.4% and 8.8% of cases, respectively. Multiple body regions were involved in 19.4% of victims. With respect to severity, moderate injuries were the most prevalent (44.4%), whereas severe injuries occurred in 25.6% of cases and minor injuries in 30.0%.

Use of protective measures and involvement of alcohol are presented in Table 5. Among two-wheeler users, only 29.9% wore helmets, while 70.1% did not. Alcohol consumption was suspected clinically in 13.1% of victims and confirmed through chemical analysis in 5.6%. The majority (81.3%) showed no evidence of alcohol intake.

. Table 1. Sociodemographic Characteristics of RTA Victims (n = 320)

Table 2. Role in Road Traffic Event and Mechanism of Accident (n = 320)

Table 3. Pattern and Nature of Injuries (Multiple Responses; n > 320)

Table 4. Anatomical Distribution and Severity of Injuries (n = 320)

Table 5. Protective Measures and Alcohol Involvement

DISCUSSION

This hospital-based series of 320 medicolegal RTA cases found that young adults (18–45 years) and males predominated, motorcyclists comprised the largest road-user group, lower-limb and head–neck injuries were most frequent, and a substantial proportion sustained moderate to severe injuries. Low helmet use among two-wheeler users and the presence of alcohol in a minority of cases were additional notable findings. These patterns largely mirror observations from other hospital- and forensic-based studies and have implications for prevention, clinical care and medicolegal practice.

Age and sex distribution in our cohort — a concentration in young, economically productive males — is consistent with multiple tertiary-center analyses which identify the 18–45 years age band and male preponderance as the groups most affected by RTAs [6,7]. This demographic concentration underlines the broader socioeconomic burden of RTAs and is concordant with national surveillance data showing highest crash incidence and casualties in the young adult population. [7]

The predominance of motorcyclists in our sample (44.4%) reflects the vehicle mix and road-use patterns seen in many low- and middle-income settings. Several Indian tertiary-care series and trauma-center audits report a similar overrepresentation of two-wheeler riders among admitted RTA victims, with corresponding high rates of limb and head trauma [6,8]. Two-wheeler crashes tend to produce focal impact and ejection injuries that disproportionately affect the extremities and head, which explains the anatomical pattern observed in our study (lower limbs 48.8%; head–neck 43.1%). [6,8]

Injury types in our study — abrasions and contusions being common and fractures present in nearly one-third of cases — align with prior emergency-department and trauma-registry reports where mixed soft-tissue and skeletal injuries are frequent among admitted victims [9,10]. The proportion of internal organ injuries (10.0%) and of polytrauma (multiple regions involved in 19.4%) are within ranges reported previously for hospitalized cohorts, underscoring that while many RTA victims sustain superficial injuries, a clinically important minority present with life-threatening intra-abdominal or thoracic trauma requiring urgent intervention [10,11].

Helmet use among two-wheeler users in our study was low (29.9%). Observational studies and hospital series from India consistently document suboptimal helmet wearing (and, importantly, frequent use of non-standard or improperly fastened helmets), which is associated with higher rates and greater severity of head injury and mortality [9]. Intervention studies and natural experiments also indicate reductions in head-injury mortality when helmet laws are enforced and helmet quality/use improves, reinforcing helmet promotion and enforcement as high-impact preventive measures [12].

Alcohol involvement was identified clinically in 13.1% and confirmed biochemically in 5.6% of victims in our series. This is comparable to multiple hospital-based studies which report a variable but non-negligible prevalence of alcohol among injured road users; reported rates vary by setting, case-mix (fatal vs non-fatal), and testing practices, but the consistent finding is that alcohol contributes to crash risk and injury severity in a measurable fraction of cases [11]. Strengthened roadside enforcement and post-crash toxicology can help both prevention and medicolegal documentation.

The distribution by injury severity in our study — with moderate injuries most common (44.4%) and severe injuries in about one-quarter of cases — echoes trauma-center reports showing a broad severity spectrum but a substantial burden of serious injury among admitted RTA victims [10]. This reinforces the need for trauma-system preparedness (triage, prompt imaging, surgical capability) and highlights the medicolegal importance of accurate documentation of injury severity for clinical, administrative and legal processes.

Limitations of this study merit acknowledgement. As a single-center, hospital-based medicolegal series, findings reflect the local caseload and referral patterns and may over represent more serious injuries compared with population-level crash surveillance. Alcohol testing was not uniformly available for all patients, which may underestimate chemical confirmation rates. Finally, detailed information on helmet quality, restraint use in four-wheelers, vehicle speed and road environment were not consistently recorded; these variables would enrich causal inferences about determinants of injury severity.

CONCLUSION

This study demonstrates that road traffic accidents predominantly affect young adult males, with motorcyclists representing the most vulnerable group. Limb injuries—particularly involving the lower extremities—along with head and neck trauma, were the most frequently observed patterns. A considerable proportion of victims sustained moderate to severe injuries, emphasizing the significant clinical and medicolegal burden associated with RTAs. The low uptake of protective measures such as helmet use, combined with detectable alcohol involvement in a subset of cases, highlights preventable contributors to injury severity. Strengthening enforcement of traffic safety regulations, promoting consistent use of protective gear, and implementing targeted public awareness initiatives are essential to reducing the incidence and impact of RTA-related injuries.

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