A Systematic Review of Epidemiological Trends, Contributing Variables, and Public Health Implications of Road Traffic Accidents in India

Abstract

BACKGROUND AND OBJECTIVE: Road traffic accidents (RTAs) constitute a critical public health emergency in India, imposing heavy mortality, morbidity, and economic burdens. Young adults and vulnerable road users such as two-wheeler riders and pedestrians are disproportionately affected. Despite legislative reforms such as the Motor Vehicles enforcement and preventive strategies remain inadequate.

METHODS: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A total of nine observational studies published between 2015 and 2025 were analyzed, alongside official data from the Ministry of Road Transport and Highways (MoRTH). Eligible studies included hospital-based cohorts, multicenter trauma studies, and epidemiological analyses, with outcomes focusing on injury mechanisms, clinical management, and mortality.

RESULTS: In 2022, MoRTH reported 4,61,312 accidents, 1,68,491 deaths, and 4,43,366 injuries, with 70% of fatalities occurring among individuals aged 18–45 years. Over-speeding accounted for 72.3% of deaths, with two-wheeler riders (44.5%) and pedestrians (18.9%) most affected. Clinical studies highlighted head injuries as the leading cause of trauma mortality, particularly in pediatric and motorcycle-related accidents. Helmet use reduced severe head injuries and mortality to 0% in comparative cohorts. Pelvic fractures (77.3% RTA-related) frequently co-occurred with abdominal and spinal injuries, with mortality linked to associated trauma and hemodynamic instability. Non-operative management proved effective for 84–90% of blunt abdominal and liver injuries, while the CRASH model demonstrated strong predictive accuracy for traumatic brain injury outcomes (AUC 0.885–0.901).

CONCLUSION AND IMPLICATIONS FOR TRANSLATIONS: RTAs in India reflect a multifactorial crisis driven by behavioral risk factors, infrastructural deficiencies, and enforcement gaps. Evidence supports helmets as highly protective, while timely surgical intervention and structured trauma care pathways improve outcomes in complex injuries. Strengthening trauma systems, enforcing protective gear legislation, and addressing myths about helmet use remain urgent priorities. Integrated public health, engineering, and policy interventions are essential to reduce the mortality, morbidity, and economic losses associated with RTAs in India.