Injury patterns and predictors of surgical intervention in road traffic accident patients presenting to the emergency department

Road traffic accidents (RTAs) impose substantial clinical and operational burdens on emergency departments (EDs). Identifying the injury patterns and predictors of surgical intervention is essential for trauma system planning and triage optimization. This study aimed to characterize the injury distribution and identify the independent predictors of surgical intervention in RTA patients presenting to a high-volume tertiary trauma center. This retrospective cohort study evaluated all patients presenting to the ED following RTAs between January 1 and December 31, 2024. Data were obtained from electronic medical records. Variables included age, sex, initial hemodynamic status, mechanism of injury, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), anatomical injury regions, imaging utilization, transfusion requirement, and hospital length of stay. The primary outcome was the requirement for surgical intervention, defined as any operative procedure or major therapeutic intervention requiring surgical team involvement, encompassing both traditional operating room procedures and life-saving bedside interventions. Secondary outcomes included injury distribution patterns across anatomical regions and clinical outcomes, such as mortality and patient clinical disposition. Of 4747 included patients, the median age was 26 years, and 74.7% were male. Motorcycle injuries (49.3%) were the leading mechanism. Surgical intervention was required in 470 patients (9.9%). Tibial (23.4%) and femoral (13.8%) fractures were the most frequent operative indications. Surgically managed patients had higher ISS (median 9 vs 2), greater transfusion needs (24.5% vs 0.4%), and longer hospital stays (p < 0.001). Age (OR 1.03), male sex (OR 1.43), hemodynamic instability on ED arrival (OR 4.63), lower GCS (OR 1.13), lower extremity trauma (OR 2.32), head-maxillofacial trauma (OR 1.52), abdominal or pelvic trauma (1.38), motorcycle crashes (compared with vehicle occupants, OR 2.03), and pedestrian crashes (compared with vehicle occupants, OR 1.67) independently predicted surgical intervention. The need for surgical intervention in RTA patients is primarily driven by physiological status, specific injury mechanisms, and the distribution of anatomical injuries. Incorporating physiological status and mechanism-informed triage pathways into trauma protocols may enhance surgical readiness, optimize resource allocation, and improve care delivery in high-volume urban trauma centers.