Patterns of injuries in pedestrian road traffic accidents: A comparative analysis of deceased and surviving victims admitted to Teaching Hospital Karapitiya, Sri Lanka

Introduction: Pedestrian road traffic injuries represent a significant public health and medico-legal concern in Sri Lanka. Understanding injury patterns and mechanisms among pedestrian victims is essential for prevention strategies, trauma management, and forensic evaluation.
Methods: A retrospective observational study was conducted using medico-legal examination forms (MLEFs) and post-mortem reports (PMRs) of pedestrians admitted to Teaching Hospital Karapitiya, Sri Lanka, from 2023 to 2024. Victims were categorized into deceased and survivors. Demographic characteristics, vehicle types involved, injury patterns, mechanisms of injury (ground impact, primary impact), and type of death were analyzed descriptively.
Results: A total of 234 pedestrian victims were included, comprising 154 survivors (65.8%) and 80 deceased (34.2%). Males constituted the majority of both survivors and fatalities. Among deceased pedestrians, the 41-60 years age group was the most affected, while the 21- 40 years age group predominated among survivors. Ground impact injuries were significantly more common among deceased victims and were particularly frequent in on- the-spot deaths. Survivors more commonly sustained extremity injuries, whereas fatalities predominantly involved severe head injuries, including skull fractures and intracranial hemorrhages. Motorcycles were the most frequently involved vehicles in both groups. Delayed deaths were commonly observed following hospital admission, particularly among patients who had undergone surgical intervention for head injuries.
Conclusion: Distinct injury patterns were observed between surviving and deceased pedestrian victims. Ground impact injuries (tertiary impact) and severe head trauma were strongly associated with fatal outcomes, while survivors more frequently sustained non- fatal extremity injuries. These findings emphasize the importance of mechanism- based injury assessment in medico-legal investigations and highlight the need for targeted preventive strategies to reduce pedestrian mortality in Sri Lanka.