Road traffic injuries in Kandy District, Sri Lanka: a prospective analysis of trauma and disability at a tertiary care center.
International journal of emergency medicine · 2026-08-25 · Observational study
Abstract
BACKGROUND: Road traffic injuries (RTIs) are a leading cause of mortality and disability globally, with the greatest burden borne by low- and middle-income countries (LMICs). Sri Lanka continues to experience substantial RTI burden, yet prospective data describing injury characteristics and short-term functional outcomes outside the capital remain limited. We aimed to describe patterns of injury and trauma severity, modes of transport and access to care, and short-term functional outcomes at discharge and during early follow-up among patients presenting with road traffic injuries to a tertiary hospital in Sri Lanka's Central Province. METHODS: We conducted a prospective observational study at National Hospital Kandy from March-September 2024. Consecutive patients presenting with road traffic-related injuries were prospectively enrolled.Trained research assistants collected sociodemographic, crash and transport characteristics, and clinical data using standardized structured interviews and bedside chart review in REDCap (English/Sinhalese/Tamil). Trauma severity was assessed using the Kampala Trauma Score (KTS). Functional disability was measured at discharge and at 3 and 6 weeks post-injury using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Analyses were descriptive. RESULTS: A total of 567 patients were enrolled (mean age 37.8 years; 77.1% male). Motorcycle drivers (37.1%) and pedestrians (16.2%) were the most common road users. Injuries most frequently involved the lower extremities (56.1%), upper extremities (50.6%), and head (25.4%). Among injured patients, injuries spanned a mean of 1.6 body regions per patient. Mean KTS was 8.29; 61.6% had mild trauma, 22.0% moderate trauma, and 14.8% severe trauma. Transport occurred by ambulance in 48.3% of cases and by three-wheeler in 31.0%. Functional disability was common at discharge (mean WHODAS 19.9) and improved over time; however, persistent disability was observed among respondents. CONCLUSIONS: RTIs presenting to a tertiary hospital in Sri Lanka's Central Province were associated with substantial injury burden and functional disability, particularly among motorcyclists and pedestrians. These prospective data provide a foundation for local injury prevention and trauma care planning in regions outside the capital. Findings support further evaluation of prehospital transport pathways and documentation practices, and underscore the value of scalable trauma data infrastructure to enable coordinated, data-driven injury prevention and trauma care in similar LMIC settings.