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Pattern of Severity of Road Traffic Injuries Among Pedestrians in Low- and Middle-Income Countries: A Systematic Review

Background: Low-and middle-income countries (LMICs) contribute about 93 per cent of road traffic injuries (RTIs) and deaths worldwide with a significant proportion of pedestrians (22 per cent). Various scales are used to assess the pattern of injury severity, which are useful in predicting the outcomes of RTIs. We conducted this systematic review to determine the pattern of RTI severity among pedestrians in LMICs. Methods: We searched the electronic databases PubMed, CINHAL, CENTRAL, Web of Science, Scopus, EMBASE, ProQuest and SciELO, and examined the references of the selected studies. Original research articles published on the RTI severity among pedestrians in LMICs during 1997-2016 were eligible for this review. Quality of publications was assessed using an adapted Newcastle-Ottawa Scale of observational studies. Findings of this study were presented as a meta-summary. Results: Five articles from 3 LMICs were eligible for the systematic review. Abbreviated Injury Score, Glasgow Coma Scale and Maxillofacial Injury Severity Score were used to assess the injury severity in the selected studies. In a multicentric study from China (2013), 21, 38 and 19 per cent pedestrians with head injuries had AIS scores 1-2, 3-4 and 5-6, respectively. In another study from China (2010), the proportion of AIS score 1-2 and AIS score 3 and above (serious to un-survivable) injuries occurred due to crash with sedan cars were 65 and 35 per cent, respectively. Such injuries due to minivan crashes were 49.5 per cent and 50.5 per cent, respectively. Two studies Ikeja, Nigeria (2014) and Elazig, Turkey (2009) presented, 24.5 and 32.5 per cent injured had a severe head injury (GCS < 8), respectively. In another study from Ibadan, Nigeria (2014), the severe maxillofacial injuries were seen in the victims of car/minibus pedestrian crashes 46 per cent, and 17 per cent had a fatal outcome. Conclusion: A varied percent of pedestrians (24.5 to 57 percent) had road traffic injuries of serious to fatal nature, depending on type of collision and injury severity scale. This study pressed the need to conduct studies with a robust methodology on the pattern of RTI severity among pedestrians to guide the programme managers, researchers and policymakers in LMICs to formulate the policies and programmes to save the pedestrian lives. Keywords: Pedestrian, Road Traffic Injuries, Injury Severity, Low-and middle-income countries.