Factors associated with road traffic injury severity among victims retrieved by pre-hospital emergency services in Rwanda

Abstract

Background: Traumatic injuries remain critical public health concerns, placing psychosocial and economic burdens on individuals, families, and healthcare systems. Despite being a leading cause of morbidity and mortality globally, especially in low-and middle-income countries, few studies have examined predictors of injury severity in pre-hospital settings. Most research focuses on injury incidence, with limited attention to pre-hospital factors. We aimed assessing the prevalence of severe injuries and their associated factors among patients managed by pre-hospital emergency services. Methods: This cross-sectional study utilized medical registry data from 1,162 RTI victims. Demographic, epidemiological, and clinical information were collected, with injuries categorized as severe or non-severe based on the Injury Severity Score. Bivariate and multivariable logistic regression models were conducted to indicate associated factors of severe injury. Results: Among 1162 victims, 165 (14%) experienced severe injury. Our results showed that females were less likely to experience severe injury (aOR=0.47, 95%CI:0.26–0.79) than males. Regarding trauma mechanism, car-to-pedestrian collisions (aOR=2.3, 95%CI:1.25–4.1), car-to-motorcycle collisions considerably increased the likelihoods of severe injury (aOR=3.88, 95%CI:1.16–13.05) compared to car-only crashes. Alcohol users were more likely to experience severe injury (aOR=3.37; 95%CI: 2.04-5.56) than non-users. Those who travelled distance ranged 21-40 km had higher likelihoods (aOR=2.91, 95%CI:1.27–6.63), while those with more than 40 km faced higher likelihoods of severe injury (aOR=2.64, 95% CI:1.11–6.25) than individuals with less than 20 km to reach to a healthcare facility. Those with extremity injuries (aOR=0.28, 95% CI:0.15–0.52), chest injuries (aOR=0.40, 95%CI:0.23–0.71, p=.002) had lower likelihoods of severe injury than those with head trauma. Conclusion: This study provides valuable insights into the factors influencing injury severity in the pre-hospital setting. The findings underscore the importance of strengthening early identification and rapid stabilization of high-risk patients during pre-hospital care. Future research using prospective longitudinal designs is recommended to confirm causality.