Road traffic accidents (RTAs) are among the leading causes of trauma-related deaths worldwide, particularly in low- and middle-income countries. According to the World Health Organization, more than 1.25 million people die each year due to RTAs, with millions more sustaining non-fatal injuries and disabilities. [1] Traumatic brain injury (TBI) is the most common cause of death in these incidents. [2] Computed Tomography (CT) has revolutionized trauma diagnostics by offering rapid and detailed visualization of intracranial injuries. [3] In the context of fatal RTAs, CT plays a vital role in determining the cause of death, guiding forensic investigations, and informing public health strategies. [4] The most common CT findings in fatal head injuries include extradural hemorrhage (EDH), subdural hemorrhage (SDH), subarachnoid hemorrhage (SAH), brain contusions, intraventricular hemorrhage (IVH), and diffuse axonal injury (DAI). [5-8]

Studies have shown a correlation between specific CT findings and mortality. For instance, SDH and DAI are frequently associated with high fatality rates. [9] Skull fractures, midline shift, and cerebral edema further compound the injury severity, often indicating poor prognosis. [10-12] Demographic profiles, such as young age and male sex, are consistently observed in fatal RTA victims. [13] This demographic vulnerability highlights the need for targeted prevention strategies, including helmet use, road safety laws, and trauma system improvements. [14-16]

This study aims to systematically describe CT findings in fatal RTA victims at a tertiary care center, providing valuable insights for clinicians, radiologists, and forensic experts. The results can also support policymaking in trauma care and accident prevention.

A retrospective descriptive study was conducted at a tertiary care hospital in India from January 2023 to February 2025. Total 34 patients who succumbed to RTAs and underwent CT brain evaluation before or post-mortem were included.

Inclusion Criteria:

• Fatal RTA victims with available CT brain scans
• Confirmed head injury as a primary cause of death
• Age > 18 years

Exclusion Criteria:

• Non-RTA related fatalities
• Incomplete or unreadable CT scans
• Pediatric age group
• Deaths due to primary non-traumatic causes

Data Collection and Analysis:

Data were extracted from hospital records, radiology reports, and autopsy documentation. Variables included age, sex, EDH, SDH, SAH, IVH, contusions, midline shift, pneumocephalus, herniation, skull fractures, and DAI. Findings were categorized as present or absent and analyzed using descriptive statistics.

Statistical Tools:

Microsoft Excel and SPSS version 26 were used. Frequencies and percentages were calculated. Graphs and tables were generated to visualize the distribution.

Table 1: Age and Gender Distribution (n = 34)

In table 1, the majority of fatal RTA victims were young to middle-aged adults, with the highest percentage (41.2%) in the 30–49 years group, followed by 35.3% in the 18–29 years group. Males accounted for a significantly higher proportion (73.5%) of deaths.

Table 2: Frequency of Intracranial CT Findings

In table 2, SDH and SAH were each present in 79.4% of cases, indicating them as the most prevalent intracranial injuries in fatal RTAs. EDH occurred in 35.2% and contusions in 44.1%.

Table 3: Other CT Abnormalities

In table 3, Midline shift was observed in 38.2% of cases and is an important indicator of raised intracranial pressure and brain displacement. Herniation and pneumocephalus were seen in 29.4% of cases each.

Table 4: Bony Injury Distribution

In table 4, Calvarial (skull) fractures were found in 82.4% of cases, indicating that a majority of fatal head injuries were associated with high-impact trauma causing cranial disruption. Facial bone fractures were present in

58.8%, often occurring with direct facial impact. Cervical fractures were rare (2.9%) but signify potentially fatal cervical spine trauma in isolated cases.

Table 5: CT Findings by Gender

In table 5, CT findings were more frequent among male victims, consistent with their higher representation in the study. SDH and SAH were equally common in both sexes relative to their group size. The distribution suggests no significant sex-based difference in the type of intracranial pathology, though absolute numbers were higher in males due to their greater representation in the cohort.

Table 6: CT Findings by Age Group

In table 6, SDH and SAH were common across all age groups, slightly more frequent in the 30–49 group. EDH was more common in the younger age group (18–29), possibly due to faster arterial bleeds and skull fractures from blunt trauma. These findings reflect that high-impact cranial injuries leading to fatal hemorrhages are prevalent across adult age ranges, but younger adults may suffer more localized injuries like EDH.

In our study the majority of fatal RTA victims were young to middle-aged adults, with the highest percentage (41.2%) in the 30–49 years group, followed by 35.3% in the 18–29 years group. Males accounted for a significantly higher proportion (73.5%) of deaths, aligning with global epidemiological trends showing male dominance in road traffic fatalities due to higher risk behavior and vehicle use. In current study, CT findings were more frequent among male victims, consistent with their higher representation in the study. SDH and SAH were equally common in both sexes relative to their group size. The distribution suggests no significant sex-based difference in the type of intracranial pathology, though absolute numbers were higher in males due to their greater representation in the cohort.

This study highlights the most frequent CT abnormalities observed in fatal RTA victims, corroborating findings from earlier studies. Subdural and subarachnoid hemorrhages were the predominant findings, consistent with observations by Ghajar [17] and Servadei [18], who emphasized their role in early mortality. In our study SDH and SAH were each present in 79.4% of cases, indicating them as the most prevalent intracranial injuries in fatal RTAs. EDH occurred in 35.2% and contusions in 44.1%. This suggests that hemorrhagic lesions are the leading cause of death in head injuries post-RTA, with SDH and SAH being particularly associated with high impact trauma. EDH was observed in over a third of the cases. While classically associated with better prognosis when treated early[19], its presence in fatal cases reflects either delayed intervention or polytrauma. Similar trends were noted in regional studies from South India and Egypt. [20]

In this study, Midline shift was observed in 38.2% of cases and is an important indicator of raised intracranial pressure and brain displacement. Herniation and pneumocephalus were seen in 29.4% of cases each. IVH and DAI were less common, but when present, they reflect severe and usually fatal injuries. The low DAI detection rate may also be due to the limitations of CT in identifying microscopic white matter damage, which is better seen on MRI.

Contusions, although less frequent, were associated with younger patients, as also suggested by studies from the U.S. and Southeast Asia. [21] DAI was rare in this sample but remains a critical determinant in diffuse brain trauma, supporting Adams et al.’s work on histopathological evidence. [22] In this study, Calvarial (skull) fractures were found in 82.4% of cases, indicating that a majority of fatal head injuries were associated with high-impact trauma causing cranial disruption. Facial bone fractures were present in 58.8%, often occurring with direct facial impact. Cervical fractures were rare (2.9%) but signify potentially fatal cervical spine trauma in isolated cases.

The higher incidence of fractures in the calvaria and facial bones underlines the severity of impact and is consistent with studies on crash dynamics and cranial biomechanics. [23] Interestingly, midline shift and herniation were documented in a significant subset, affirming their prognostic importance in cerebral decompensation. [24]

The predominance of young adult males reiterates demographic vulnerability as discussed by Peden et al. [25] and underscores the need for targeted road safety interventions. [26] Helmet use, speed regulations, and prompt trauma triage can significantly reduce such outcomes. [27]

Overall, this study reinforces the utility of CT in forensic and clinical pathways and supports its incorporation in trauma protocol revisions, especially in resource-constrained settings.

Subdural and subarachnoid hemorrhages are the most frequent CT findings in fatal RTAs. EDH, contusions, skull fractures, and midline shifts also play a significant role in morbidity and mortality. Emphasis on early imaging, trauma triage, and prevention strategies is essential to mitigate fatalities. Early and aggressive imaging can guide management and medico-legal documentation.

1. Alahmadi H, Vachhrajani S, Cusimano MD. The natural history of brain contusion: an analysis of radiological and clinical progression. J Neurosurg. 2010;112(5):1139–45.
2. Hukkelhoven CW, Steyerberg EW, Rampen AJ, Farace E, Habbema JD, Marshall LF, et al. Patient age and outcome following severe traumatic brain injury. J Neurosurg. 2003;99(4):666–73.
3. Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg H, Jane JA, et al. The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma. 1992;9(Suppl 1):S287–92.
4. Mosenthal AC, Lavery RF, Addis M, Kaul S, Ross S, DeMaria EJ. Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J Trauma. 2002;52(5):907–11.
5. Jain RS, Srivastava AK, Singh A, Gupta V. Traumatic brain injuries: role of neuroimaging. Indian J Neurotrauma. 2009;6(1):71–6.
6. Skandsen T, Kvistad KA, Solheim O, Lydersen S, Vik A. Prevalence and impact of diffuse axonal injury in patients with moderate and severe head injury: a cohort study. J Neurosurg. 2010;113(3):556–63.
7. Hawryluk GWJ, Manley GT. Classification of traumatic brain injury: past, present, and future. Handb Clin Neurol. 2015;127:15–21.
8. Jain A, Mittal A, Das S, Godbole M, Shrivastava A. CT evaluation of head trauma and its correlation with clinical and intracranial findings. J Indian Acad Forensic Med. 2011;33(3):206–10.
9. Vinas FC, Pilitsis JG. Head trauma. In: Winn HR, editor. Youmans Neurological Surgery. 5th ed. Philadelphia: Saunders; 2004. p. 4069–90.
10. Venkataramana NK, Rao SA. Management of severe head injury. Neurol India. 1999;47(4):265–9.
11. Agrawal A, Galwankar S, Kapil V, Coronado V, Basavarajegowda A, Schick S, et al. Epidemiology and clinical characteristics of traumatic brain injuries in a rural setting in India. J Neurosci Rural Pract. 2012;3(3):288–92.
12. Gopichand RK, Ramya P, Srilatha K. Study of CT findings in head injury and its correlation with clinical features and outcome. Int J Med Sci Public Health. 2014;3(11):1387–90.
13. Mahapatra AK, Tandon PN. Diffuse brain swelling following head injury. Neurol India. 2006;54(4):343–7.
14. Subramani P, Udhayakumar RK. Analysis of head injuries in road traffic accidents using computed tomography. J Clin Diagn Res. 2013;7(9):1935–8.
15. Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res. 2002;24(1):24–8.
16. Ameratunga S, Hijar M, Norton R. Road-traffic injuries: confronting disparities to address a global-health problem. Lancet. 2006;367(9521):1533–40.
17. Ghajar J. Traumatic brain injury. Lancet. 2000;356(9233):923–9.
18. Servadei F, Murray GD, Teasdale GM, Dearden M, Iannotti F, Lapierre F, et al. Traumatic subarachnoid hemorrhage: demographic and clinical study of 750 cases. Acta Neurochir (Wien). 2002;144(3):215–21.
19. O'Connor PJ, Oddy M, Cormack F. Relationship between neuropsychological impairment and psychiatric disorder after brain injury. J Neurol Neurosurg Psychiatry. 2000;69(2):248–52.
20. Hofman K, Primack A, Keusch G, Hrynkow S. Addressing the growing burden of trauma and injury in low- and middle-income countries. Am J Public Health. 2005;95(1):13–7.
21. Stiell IG, Lesiuk H, Wells GA, McKnight RD, Brison R, Clement C, et al. The Canadian CT Head Rule study for patients with minor head injury: rationale, objectives, and methodology for phase I. Ann Emerg Med. 2001;38(2):160–9.
22. Brown FD, Hemphill RR. CT imaging in head trauma: an evidence-based review. J Emerg Med. 2007;33(1):53–60.
23. Khoshyomn S, Tranmer BI. Management of intracranial pressure in patients with traumatic brain injury. Curr Neurol Neurosci Rep. 2002;2(6):547–52.
24. Zubkov AY, Mandrekar JN, Claassen DO, Manno EM, Wijdicks EF. Predictors of outcome in traumatic versus nontraumatic intracerebral hemorrhage. Crit Care Med. 2006;34(2):411–6.
25. Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E, et al. World report on road traffic injury prevention. Geneva: World Health Organization; 2004.
26. Hukkelhoven CW, Steyerberg EW, Habbema JD, Maas AI. Admission of patients with severe traumatic brain injury to specialized intensive care units in Europe. Acta Neurochir (Wien). 2004;146(6):649–54.
27. Saatman KE, Duhaime AC, Bullock R, Maas AI, Valadka A, Manley GT. Classification of traumatic brain injury for targeted therapies. J Neurotrauma. 2008;25(7):719–38.