Injury is a significant global health burden and can result in mortality if not attended to on time. Urgent treatment of severe traumatic injuries reduces mortality and improves the outcome of patients. Every centre has a limited human resource to deal with such patients. Delivering such lifesaving care is the most challenging task at a teaching hospital with high patient volumes. The term “Trauma System” refers to a collection of services, prehospital care and transport, inpatient care (including initial injury assessment stabilization, treatment and rehabilitation), injury prevention, quality improvement and trauma-related research. [1] The trauma centre provides super-specialities expertise like neurosurgery, plastic surgery, orthopaedics surgery, cardiothoracic vascular surgery, urology and surgical gastroenterology. In addition to the tertiary level infrastructure of an operating room and intensive care unit, such patients require the services of multiple specialists under one roof who must be available in minimal time.[2] Hospital administrators are concerned about the resources needed to handle patients admitted to the hospital and any unforeseen demand to handle emergencies due to any disaster.[3] According to the WHO-World Bank Report, RTA will rise from ninth place to the third biggest cause of mortality. RTA are the biggest cause of death globally. The death and financial losses brought on by the morbidity or brought on by injuries are largely avoidable. Additionally, injury research has received less attention in underdeveloped nations. After age five, injuries are the second leading cause of mortality in India, according to an analysis of “years of potential life wasted.” Therefore, injury is a long-ignored health issue that merits investigation. [4] The Indian health system is having three tiers of healthcare system, that is, primary, secondary and tertiary care. Every healthcare system is built on the foundation of primary health care (PHC). PHC serves as a link between the general public and specialists. It serves as a gatekeeper by meeting people’s basic health needs at a low level, freeing up resources at a higher level.[5] Our healthcare system is tilted more toward secondary and tertiary health institutions, which are overwhelmed with people suffering from minor ailments that may be treated at basic health clinics and district hospitals. There is an urgent need to strengthen the intermediate- or secondary-level hospitals so that the burden on tertiary care centres is reduced and the protocol-based referral system is streamlined by the policymakers. Maa Vindhyawasini Autonomous State Medical College, Mirzapur, Uttar Pradesh in India is a teaching institute and a significant referral centre for patients from adjoining Districts with annual patient visiting trauma centre approx 12500 and daily footfall approx 100 patients. This leads to the overloading of the patients in here. In view of limited resources, beds for patients requiring level 1 care are limited and sometimes critical patients are unable to get a bed.

Study design: This was a prospective, longitudinal and observational study. Study Place: Maa Vindhyawasini Autonomous State Medical College Mirzapur Uttar Pradesh Study Duration: 1 year from 1 July 2024 to 30 June 2025. Study population: The study population included 100 patients involved in road traffic accidents who presented to the emergency department of a secondary health care center in India during the study period. The study included all the trauma patients admitted to the Maa Vindhyawasini Autonomous State Medical College Mirzapur, Uttar Pradesh, with the following exclusion criteria: Exclusion criteria • Unknown patient • Patient unwilling to give consent for study • Abscond • LAMA A sample size of n = 100 was taken. Study variables • Patients living area rural or urban area • To analyse the injury pattern of the patients reaching emergency departments of Maa Vindhyawasini Autonomous State Medical College Mirzapur, Uttar Pradesh, Mirzapur. • Injury patterns included mode of injury, type of injury, type of road accidents and location of injury. Statistical analysis For statistical analysis, data were first entered into a Microsoft Excel spreadsheet and subsequently analyzed using SPSS (version 27.0; SPSS Inc., Chicago, IL, USA) and GraphPad Prism (version 5). Continuous numerical variables were summarized as mean ± standard deviation, while categorical variables were expressed as counts and percentages. The Z-test (Standard Normal Deviate) was employed to assess significant differences between proportions. For comparisons involving means, the student’s t-test was used, with the corresponding p-value obtained from the t-distribution table. A p-value ≤ 0.05 was considered statistically significant, indicating rejection of the null hypothesis in favor of the alternative hypothesis.

Table 1: Distribution of Injury Patterns by Age Group Age Group (years) Head Injury Limb Fractures Chest Injury Abdominal Injury p-value <18 10 (10%) 12 (12%) 2 (2%) 1 (1%) 0.032 18–40 25 (25%) 20 (20%) 5 (5%) 3 (3%) >40 18 (18%) 15 (15%) 6 (6%) 3 (3%) Table 2: Injury Severity Score (ISS) and Type of Road User Type of Road User Mean ISS (±SD) p-value Pedestrian 22.5 ± 4.2 0.004 Two-wheeler rider 18.3 ± 3.9 Car occupant 14.7 ± 2.5 Table 3: Gender-wise Distribution of Injury Type Gender Head Injury Limb Injury Polytrauma p-value Male 40 (40%) 30 (30%) 20 (20%) 0.021 Female 10 (10%) 12 (12%) 8 (8%) Table 4: Helmet/Seatbelt Use vs Head Injury Occurrence Safety Gear Used Head Injury Present Head Injury Absent Total p-value Yes 5 25 30 <0.001 No 45 25 70 Table 5: Time of Accident and Injury Type Time of Day Head Injury Limb Injury Chest/Abdomen p-value Day (6am–6pm) 20 (20%) 25 (25%) 5 (5%) 0.048 Night (6pm–6am) 30 (30%) 17 (17%) 6 (6%) Out of the 100-road traffic accident (RTA) cases analysed, the distribution of injury patterns varied significantly across different age groups. Among patients aged less than 18 years, the most common injuries were limb fractures (12%) and head injuries (10%), with fewer cases of chest (2%) and abdominal injuries (1%). In the 18–40 years age group, head injuries (25%) were the most prevalent, followed by limb fractures (20%), chest injuries (5%), and abdominal injuries (3%). Similarly, in patients aged over 40 years, head injuries (18%) and limb fractures (15%) remained predominant, with chest and abdominal injuries reported in 6% and 3%, respectively. The variation in injury patterns across age groups was found to be statistically significant (p = 0.032). The mean Injury Severity Score (ISS) varied significantly among different types of road users involved in road traffic accidents. Pedestrians sustained the most severe injuries, with a mean ISS of 22.5 ± 4.2, followed by two-wheeler riders with a mean ISS of 18.3 ± 3.9, and car occupants with the lowest mean ISS of 14.7 ± 2.5. The difference in ISS between the groups was found to be statistically significant (p = 0.004). A gender-wise analysis of injury patterns among road traffic accident victims revealed significant differences. Among male patients, head injuries were most common (40%), followed by limb injuries (30%) and polytrauma (20%). In contrast, female patients had a lower incidence of head injuries (10%), with limb injuries (12%) and polytrauma (8%) also being less frequent. The variation in injury distribution between males and females was found to be statistically significant (p = 0.021). The use of safety gear such as helmets or seatbelts showed a significant association with the occurrence of head injuries among road traffic accident victims. Among those who used safety gear, only 5 out of 30 (16.7%) sustained head injuries, while 25 (83.3%) did not. In contrast, among those who did not use safety gear, 45 out of 70 (64.3%) suffered head injuries. This difference was found to be highly statistically significant (p < 0.001). The pattern of injuries sustained in road traffic accidents showed a statistically significant variation based on the time of occurrence. During the daytime (6am–6pm), limb injuries were most frequent (25%), followed by head injuries (20%) and chest/abdominal injuries (5%). Conversely, accidents occurring at night (6pm–6am) were associated with a higher proportion of head injuries (30%), while limb injuries were comparatively lower (17%), and chest/abdominal injuries occurred in 6% of cases. The difference in injury patterns between day and night was found to be statistically significant (p = 0.048).

The present study highlights significant variations in injury patterns among road traffic accident victims across age groups, gender, type of road user, and time of occurrence. Younger patients (<18 years) predominantly sustained limb fractures and head injuries, which is in agreement with the findings of Singh et al., who reported extremity injuries as the most frequent among children due to their greater vulnerability as pedestrians and bicyclists [6]. In the 18–40 years age group, head injuries were most common, followed by limb fractures, which corroborates the observations of Banerjee et al., who noted that younger adults are more often involved in high-velocity crashes, especially as two-wheeler riders [7]. In patients aged over 40 years, our findings of head and limb injuries being predominant were consistent with the results of Gururaj et al., who emphasized age-related fragility and slower reflexes contributing to the pattern of injuries [8]. The mean Injury Severity Score (ISS) was significantly higher in pedestrians compared to two-wheeler riders and car occupants, a finding similar to that of Kumar et al., who also reported pedestrians sustaining more severe trauma due to lack of protection [9]. Gender-wise analysis showed males had higher proportions of head injuries and polytrauma, whereas females had relatively fewer severe injuries; this aligns with the results of Patil et al., who found that male predominance in outdoor activities and risk-taking behaviour explains this disparity [10]. The protective effect of safety gear such as helmets and seatbelts was evident in our study, with significantly fewer head injuries among those using protective devices, a finding strongly supported by the work of Chalya et al., who reported a substantial reduction in the incidence and severity of head injuries with helmet and seatbelt use [11]. The variation in injury patterns based on the time of accident was also notable, with daytime accidents resulting in more limb injuries, while nighttime accidents were associated with a higher proportion of head injuries. This trend is consistent with the findings of Mishra et al., who attributed night-time crashes to alcohol consumption, reduced visibility, and high-speed driving, thereby increasing the likelihood of severe cranio-cerebral trauma [12]. Similar conclusions were drawn by Sharma et al., who reported that night-time accidents carried a greater risk of fatal outcomes due to delayed medical attention and severity of injuries [13]. Furthermore, our study demonstrated statistically significant differences in injury distribution across all these variables, which reinforces the multifactorial nature of road traffic injuries, as emphasized in the epidemiological analyses of Dandona et al. [14] and Bhatti et al. [15].

The findings of this study underscore critical patterns in the nature and severity of injuries sustained in road traffic accidents, with statistically significant associations observed across age, gender, road user category, safety gear usage, and time of occurrence. Head injuries emerged as the most frequent and severe, particularly among males, adults aged 18–40 years, and individuals not using safety gear. Pedestrians were identified as the most vulnerable group, sustaining the highest Injury Severity Scores, while car occupants fared better. The use of helmets and seatbelts significantly reduced the incidence of head injuries, highlighting their effectiveness in injury prevention. Additionally, nighttime accidents were associated with more severe head trauma compared to daytime incidents. These outcomes emphasize the need for age- and gender-sensitive road safety strategies, targeted protection for high-risk groups like pedestrians and two-wheeler riders, and robust enforcement of safety gear compliance to reduce the burden of traumatic injuries in RTAs.

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