The Impact of Mode of Transport and Adequacy of Pre-Hospital Care Among Severely Injured Road Traffic Accident Patients in Addis Ababa, Ethiopia: A Retrospective Cohort Study
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Date
2025
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Addis Ababa University
Abstract
Background: Road traffic injuries (RTIs) are a major global health concern, particularly in low- and middle-income countries (LMICs) where over 90% of RTI deaths occur. Ethiopia has one of the highest RTI fatality rates in sub-Saharan Africa, with up to 37 deaths per 100,000 people. Contributing factors include poor road infrastructure, limited emergency medical services (EMS) and inadequate prehospital care. Despite EMS being crucial to reducing trauma mortality, Ethiopia lacks a formal prehospital care system, and most RTI victims are transported by informal means without emergency care. The impact of prehospital care and transport mode patient outcomes remains under-researched.
Objective: This study investigated the impact of mode of transportation and adequacy of prehospital care on clinical outcomes—mortality, discharged with disability, and discharged without disability —among severely injured RTI patients admitted to Alert Hospital Trauma Center in Addis Ababa.
Methods: A hospital-based observational study reviewed clinical records of RTI patients presenting to Alert Hospital Trauma center (2020-2023). The study included severely injured 449 adults (triaged red or orange by modified early warning score, MEWS) with recorded outcomes. Patients transported by ambulance were compared to those using non-ambulance means, and those receiving adequate pre-hospital care were compared to those with inadequate or no care. Data on demographics, clinical parameters, transport mode, provider type and outcomes were analyzed for association with RTI mortality and disability. Logistic regression was carried out to further examine significant associations to identify risk factors.
Results: Out of 18,408 trauma cases seen at the institution during study period 2,946 (16%) were RTI. Of these, 449 records of severely injured patients were identified. Out of 449 patients. males made 70.8% with median age of 35 years and pedestrians accounted for 56.1%. Prehospital care was documented in half of the patients, though only 20% received adequate care. Prehospital care was mainly given health professional (95.5%). Mortality was 16.5%, with 39.4% discharged with disability and 44.1% without disability.
Compared with private/public patients, patients arriving walking had twelve times more odds of death (AOR = 12.26, 95% CI: 2.47-60.89). Other predictors of death were age (AOR= 1.05, 95% CI: 1.03 – 1.07), female (AOR = 0.20 95% CI: 0.08-0.52) and higher systolic blood pressure (AOR xii
= 0.98%, 95% CI: 0.97-0.99). Mode of transport and higher systolic blood pressure were found to be significant predictors of disability. Compared with private/public transport, patient transported by ambulance has twice odds of being disable (AOR = 2.36, 95% CI: 1.41-3.94).
Conclusions: The study highlights a high rate of RTI in Ethiopia. Patients’ clinical outcome is significantly associated with mode of transport. Arrival on foot or carried was associated with higher mortality while arrival by ambulance increased the likelihood of disability. Although most prehospital care was provided by health professionals, only a small fraction was adequate. Strengthening EMS systems, improving timely quality prehospital care could substantially reduce death and disability among this population. Other key predictors of outcomes were age, sex and systolic blood pressure
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Keywords
clinical outcomes, emergency medical services, mode of transport, prehospital care, road traffic accidents