Road traffic accident patients presenting to the emergency department: clinical predictors of severe outcomes and mortality; a systematic review
DOI:
https://doi.org/10.65759/0f8vmz81Keywords:
Road traffic accidents, emergency department, mortality, severe outcomes, clinical predictorsAbstract
Background: Road traffic accidents (RTA) are a major cause of death, disability, and emergency care burden worldwide. This review synthesizes clinical predictors of severe outcomes and mortality in RTA patients presenting to emergency departments or related acute hospital settings. Methods: A systematic review was conducted using PubMed, Web of Science, Scopus, and Embase. Original studies reporting mortality, severe injury, disability, poor outcome, or related severe consequences in RTA patients were eligible. Screening followed a PRISMA-style process. Data were extracted on study characteristics, outcomes, and reported predictors. Findings were synthesized qualitatively. Results: Eight studies were included. Most were prospective, retrospective, cross-sectional, or cohort designs. Sample sizes ranged from 211 to 1,471 participants. Mortality ranged from 3.6% to 14.69%. Severe injury prevalence reached 36.4%, while permanent disability ranged from 4.6% to 6.1% in reported studies. Important predictors of poor outcome included low Glasgow Coma Scale, hypotension or systolic blood pressure ≤89 mmHg, head injury, multiple trauma, high injury severity, ICU admission, complications during treatment, delayed presentation, lack of first aid, lack of ambulance transport, comorbidity, rural residence, and pedestrian status. Conclusion: Predictors of severe outcomes and mortality in the included studies were severe neurological impairment, hemodynamic instability, advanced injury burden, and delayed access to care.
References
1. Adeloye D, Thompson JY, Akanbi MA, Azuh D, Samuel V, Omoregbe N, et al. Incidence des accidents, traumatismes et victimes de la route en Afrique: Revue systématique et méta-analyse. Bull World Health Organ 2016;94:510A-521A. https://doi.org/10.2471/BLT.15.163121.
2. Vissoci JRN, Shogilev DJ, Krebs E, Andrade L de, Vieira IF, Toomey N, et al. Road traffic injury in sub-Saharan African countries: A systematic review and summary of observational studies. Traffic Inj Prev 2017;18:767–73. https://doi.org/10.1080/15389588.2017.1314470.
3. Endalamaw A, Birhanu Y, Alebel A, Demsie A, Habtewold TD. The burden of road traffic injury among trauma patients in Ethiopia: A systematic review and meta-analysis. African Journal of Emergency Medicine 2019;9:S3–8. https://doi.org/10.1016/j.afjem.2019.01.013.
4. Bhattarai HK, Bhusal S, Barone-Adesi F, Hubloue I. Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review. Prehosp Disaster Med 2023;38:495–512. https://doi.org/10.1017/S1049023X23006088.
5. Yohann A, Kratzke I, Williams B, Charles A. The effect of transfer status on trauma outcomes in low- and middle-income countries: A systematic review and meta-analysis. Injury 2022;53:885–94. https://doi.org/10.1016/j.injury.2021.10.010.
6. Khari S, Zandi M, Yousefifard M. Glasgow Coma Scale Versus Physiologic Scoring Systems in Predicting the Outcome of ICU admitted Trauma Patients; a Diagnostic Accuracy Study. Arch Acad Emerg Med 2022;10. https://doi.org/10.22037/aaem.v10i1.1483.
7. Yousefifard M, Toloui A, Ahmadzadeh K, Gubari MI, Neishaboori AM, Amraei F, et al. Risk Factors for Road Traffic Injury-Related Mortality in Iran; a Systematic Review and Meta-Analysis. Arch Acad Emerg Med 2021;9. https://doi.org/10.22037/aaem.v9i1.1329.
8. Dunne J, Quiñones-Ossa GA, Still EG, Suarez MN, González-Soto JA, Vera DS, et al. The Epidemiology of Traumatic Brain Injury Due to Traffic Accidents in Latin America: A Narrative Review. J Neurosci Rural Pract 2020;11:287–90. https://doi.org/10.1055/s-0040-1709363.
9. 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 Emerg Med 2015;15. https://doi.org/10.1186/s12873-015-0035-4.
10. 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 Emerg Med 2019;19. https://doi.org/10.1186/s12873-018-0206-1.
11. Hatamabadi HR, Shojaee M, Kashani P, Mehdi Forouzanfar M, Nargesi DA, Reza M, et al. Predictive factors of poor outcome in road traffic injures; a retrospective cohort study. vol. 5. 2017.
12. Demisse A, Shore H, Ayana GM, Negash B, Raru TB, Merga BT, et al. Magnitude of death and associated factors among road traffic injury victims admitted to emergency outpatient departments of public and private hospitals at Adama Town, East Shewa Zone, Ethiopia. SAGE Open Med 2021;9. https://doi.org/10.1177/20503121211060203.
13. Kamabu K, La O Soria J, Tumwesigye D, Okedi XF, Kyomukama L, Muhumuza J, et al. 24 h mortality and its predictors among road traffic accident victims in a resource limited setting; a multicenter cohort study. BMC Surg 2023;23. https://doi.org/10.1186/s12893-023-02011-9.
14. Beyera TM, Serbessa SD, Fetensa G, Woldemichael K. Trends in fatalities from road traffic injuries and associated factors of patients admitted to the emergency department of St. Luke Hospital, South West Shewa Zone, Ethiopia. Frontiers in Disaster and Emergency Medicine 2024;1. https://doi.org/10.3389/femer.2023.1328817.
15. Deresse E, Komicha MA, Lema T, Abdulkadir S, Roba KT. Road traffic accident and management outcome among in adama hospital medical college, central ethiopia. Pan African Medical Journal 2021;38. https://doi.org/10.11604/pamj.2021.38.190.11650.
16. Afacho AA, Belayneh T, Markos T, Geleta D. Incidence and predictors of mortality among road traffic accident victims admitted to hospitals at Hawassa city, Ethiopia. PLoS One 2024;19. https://doi.org/10.1371/journal.pone.0296946.
17. Lee JW, Wang W, Rezk A, Mohammed A, Macabudbud K, Englesakis M, et al. Hypotension and Adverse Outcomes in Moderate to Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis. JAMA Netw Open 2024;7. https://doi.org/10.1001/jamanetworkopen.2024.44465.
18. Whitaker J, O’Donohoe N, Denning M, Poenaru D, Guadagno E, Leather AJM, et al. Assessing trauma care systems in low-income and middle-income countries: A systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments. BMJ Glob Health 2021;6. https://doi.org/10.1136/bmjgh-2020-004324.
19. Cuthbertson J, Drummond G. Prehospital Care Post-Road-Crash: A Systematic Review of the Literature. Prehosp Disaster Med 2025;40:94–100. https://doi.org/10.1017/S1049023X25000202.
20. Alharbi RJ, Shrestha S, Lewis V, Miller C. The effectiveness of trauma care systems at different stages of development in reducing mortality: a systematic review and meta-analysis. World Journal of Emergency Surgery 2021;16. https://doi.org/10.1186/s13017-021-00381-0.
