Epidemiological pattern of injuries among road traffic crash victims: the first experience of a large tertiary care hospital in the West Bank of Palestine

Abstract

Background

Road traffic injuries are a global public health challenge. This study was conducted to describe the epidemiological patterns of road traffic injuries in a large tertiary care hospital in the West Bank of Palestine. In addition, associations between the different variables of the victims and the patterns of road traffic injuries were also assessed.

Methods

This study was conducted in a retrospective cohort observational design between January 2021 and July 2023 at a large tertiary care hospital in Nablus, Palestine. The data were collected from the electronic medical record system of the large tertiary care hospital using a data collection form.

Results

A total of 1,544 victims of traffic road injuries were included in this study. Lower limb (43.0%), neck (41.2), and upper limb (39.8%) injuries were the most common types of road traffic injuries sustained by the victims admitted to the large tertiary care hospital.

The victims who were 30 years or older were more likely to sustain back injuries (aOR = 1.71, 95% CI: 1.20–2.45) pelvic injuries (aOR = 1.84, 95% CI: 1.08–3.12), chest injuries (aOR = 1.59, 95% CI: 1.06–2.38), and neck injuries (aOR = 2.54, 95% CI: 1.68–3.82) compared to the victims who were younger than 30 years.

The victims who did not use seatbelts were more likely to sustain abdominal injuries (aOR = 1.88, 95% CI: 1.34–2.63) and head injuries (aOR = 1.49, 95% CI: 1.06–2.10) compared to the victims who used seatbelts. The victims who did not have the airbag deployed were more likely (aOR = 1.85, 95% CI: 1.31–2.63) to sustain neck injuries compared to the victims who had the airbag deployed.

Conclusion

The epidemiological patterns of road traffic injuries in a large tertiary care hospital in Nablus, Palestine were described and the associations between the different variables of the victims and the patterns of road traffic injuries were assessed. The findings indicated a need to design measures to prevent/minimize these injuries. Future studies are still needed to determine the best measures to avoid/minimize the incidence of serious road traffic injuries.

Background

Road traffic injuries are a global public health challenge that accounts for 15% of all illnesses worldwide and causes over 6 million deaths and 52 million disability-adjusted life years annually [1]. According to the global road traffic injury statistics, road traffic deaths have increased from 1.15 million in 2000 to 1.35 million in 2018 [2]. In 2015, the United Nations (UN) included the prevention of road traffic injuries and deaths as Target 3.6 in the Sustainable Development Goals [3]. The goal was to reduce the number of global road traffic injuries and deaths by half in 2020. In Europe, the Vision Zero and Safe System approach was adopted by the European Union (EU) to minimize/eliminate serious road traffic injuries and deaths by the year 2050 [4].

Despite efforts, the global number of road traffic crashes, injuries, and deaths continue to increase steadily [2]. According to the World Health Organization (WHO), the road traffic crash is expected to rank as the 6th most common cause of death by 2030, notably in low-income countries due to inadequate safe road infrastructure [5, 6]. It is important to note that RTIs are disproportionately prevalent in low- and middle-income countries and it has been estimated that more than 90% of the burden is borne by low- and middle-income countries [7]. In early 2021, 19,000 RTIs were reported in Palestine [8]. Previous studies have reported that the most frequent road traffic injuries were in the lower extremities, chest, head, and abdomen [9–12]. Lower extremity injuries accounted for approximately 47.9%, chest injuries accounted for about 41%, head injuries accounted for 27%, and abdominal injuries accounted for 21% of road traffic injuries [9, 10]. In addition, road traffic crashes were also reported to cause genitourinary injuries, kidney traumas, and traumatic brain injuries [11, 12].

It has been argued that road traffic injuries can occur in more than one anatomic location simultaneously. Therefore, healthcare providers in trauma centers and emergency departments should be aware of the potential concurrent injuries in other anatomical sites of the body. For example, a study reported that genitourinary tract injuries were associated with other injuries in the abdomen, legs, thorax, arms, heads, and vertebrae [11].

The patterns of road traffic injuries can differ significantly among age groups. For example, subdural hematomas and skull fractures were less common in the 17-year-old and younger age group compared to the 55-year-old and older age group [13, 14]. Furthermore, head injuries were more common in men compared to women (male-to-female ratio of 10.8:1) [13]. Moreover, men in the 15–49 years age group were at higher risk of experiencing long-lasting disabilities [15].

It is well-established that wearing seatbelts and helmets protects from road traffic injuries and deaths [5, 16–18]. Previous studies have reported that road traffic injuries and deaths were less common among users of seatbelts and helmets compared to non-users [16, 19]. Splenic, renal, pancreatic, adrenal, diaphragmatic, and retroperitoneal injuries were more common among road traffic injury victims who did not use seatbelts compared to seatbelt users [10].

While effective intervention programs with quantifiable outcomes were adopted in high-income countries, the most fundamental epidemiological data relevant to the distribution of road traffic injuries are still lacking in low- and middle-income countries [9]. In Palestine, little is known about the epidemiological patterns of road traffic injuries. Moreover, data on the frequency and types of road traffic injuries in Palestine were not analyzed before. Therefore, this study was conducted to describe the epidemiological patterns of road traffic injuries in a large tertiary care hospital in Nablus, Palestine. In addition, associations between the different variables of the victims and the patterns of road traffic injuries were also assessed.

Methods

Study design and setting

This study was conducted in a retrospective cohort observational design at a large tertiary care hospital in Nablus, Palestine.

Patients and sample size

The study patients were victims of road traffic injuries who presented to the large tertiary care hospital in the period between January 2021 and July 2023. The following patients were included: 1) were victims of road traffic injuries, 2) presented to the large tertiary care hospital during the study period, 3) had complete medical records including their demographic information, type of road traffic injuries, and treatments received. In this study, an all-inclusive sampling approach was used to include all the victims who had complete medical records.

Data collection

The data were collected from the electronic medical record system of the large tertiary care hospital using a data collection form. The data collection form collected the demographic variables of the victims including age, gender, and marital status. Data relevant to the road traffic crash including the type of vehicle involved, timing of the road traffic crash, and whether the patient was wearing a seatbelt or not were also collected. In addition, the type and anatomical site of road traffic injuries were collected. The road traffic injuries were categorized based on the site as head, neck, thoracic, abdominal, pelvic, shock, burn, and polytrauma. Road traffic injuries were categorized as “shock” when the injuries resulted in polytrauma, significant blood loss, or severe compromise to the hemodynamic stability of the patients.

Statistical analysis

All data entry and analyses were performed using IBM Statistical Package for Social Sciences (IBM SPSS) for Windows, version 22.0. Means and standard deviation (SD) were used to describe the continuous variables and frequencies (n) and percentages (%) were used to describe the categorical variables. Pearson’s Chi-square tests were used to assess differences in the distribution of the categorical variables. Odds ratios were calculated using a multivariate logistic analysis retaining the variables that were significantly associated in the univariate analysis. A p-value of less than 0.05 indicated statistical significance.

Ethical approval

This study was conducted in adherence to the relevant international guidelines and regulations followed in scientific research involving human subjects. This study received ethical approval from the Institutional Review Board (IRB) of An-Najah National University (Protocol #: NNU-IRB-10–14). The privacy of the patients and confidentiality of the data were maintained throughout the study. The data collected in this study were coded. Because this study was based on the medical records of the victims of road traffic injuries, written informed consent from the victims was waived by the IRB of An-Najah National University.

Results

Demographic variables of the patients

A total of 1,544 victims of traffic road injuries who were admitted to the emergency department of the large tertiary care hospital between January 2021 and July 2023 were included in this study. The mean age of the patients was 28.5 ± 15.6 years. Figure 1 shows the age distribution of the patients.

Fig. 1.

Age distribution of the patients

Of the patients, 1,112 (72.0%) were male and 432 (28.0%) were female. More than half of the victims (66.2%) were single, while (31.2%) were married. As shown in Table 1, 241 (15.6%) patients had a past medical history, and 349 (22.6%) had a past surgical history. These details are shown in Table 1.

Table 1.

Demographic variables of the patients

Variable	n	%
Gender
Female	432	28.0
Male	1112	72.0
Marital status
Single	1022	66.2
Married	481	31.2
Divorced	1	0.1
Widow/Widower	2	0.1
Past medical history
No	1218	78.9
Yes	241	15.6
Past surgical history
No	1107	71.7
Yes	349	22.6

Type of vehicle involved in the road traffic crashes, position of the victims, deployment of the airbag, and use of helmets

Table 2 shows the type of vehicle involved in road traffic crash, the position of the victims, and deployment of the airbag, and the use of helmets. The vast majority of the victims (96.8%) sustained a car crash. The rest of the victims sustained motorcycle, bicycle, truck, and scooter crashes. Of the documented cases, 42.4% of the victims’ vehicles hit or were hit by cars and 10.9% were self- crashes. Of the victims, 29.0% were the drivers, 20.3% were in the back passenger seats, 14.4% were in the front passenger seat, and 8.2% were pedestrians in the documented cases. The airbag was deployed in 15.8% of the documented cases. Of the crashes involving motorcycles, bicycles, and scooters, 17.4% of the victims used helmets in the documented cases.

Table 2.

Type of vehicle involved in the road traffic crashes, position of the victims, deployment of the airbag, and use of helmets

Variable	n	%
Type of vehicle
Car	1494	96.8
Motorcycle	18	1.2
Bicycle	20	1.3
Truck	9	0.6
Scooter	3	0.2
The vehicle hit/was hit by
Car	654	42.4
Self-crash	169	10.9
Truck	23	1.5
Animal	5	0.3
Motorcycle	2	0.1
Bicycle	1	0.1
Missing information	690	44.7
Seat occupied by the victim
Driver	448	29.0
Back passenger seat	313	20.3
Front passenger seat	222	14.4
Pedestrian	127	8.2
Missing information	434	28.1
Deployed airbag
No	430	27.8
Yes	244	15.8
Missing information	870	56.3
Use of helmeta
No	3	13.0
Yes	4	17.4
Missing information	16	69.6

^aFor motorcycles, bicycles, and scooters

Temporal distribution of road traffic injuries

The number of road traffic injury victims admitted to the emergency department of the large tertiary care hospital in 2021 was larger than those admitted in 2022 and 2023. The number of road traffic injury victims admitted per year during the study period is shown in Fig. 2.

Fig. 2.

Number of road traffic injury victims admitted per year during the study period

The number of road traffic injury victims admitted during each month of the year is shown in Fig. 3. The largest number of victims were admitted between April and August. The least number of victims were admitted in November.

Fig. 3.

Number of road traffic injury victims admitted during each month of the year

The number of victims admitted on different days of the month are shown in Fig. 4.

Fig. 4.

Number of road traffic injury victims admitted during each day of the month

Moreover, the number of victims admitted on hours of the day are shown in Fig. 5. A considerable number of cases were admitted in the time period between 3:00 pm and 8:00 pm.

Fig. 5.

Number of road traffic injury victims admitted during each hour of the day

Anatomical site of road traffic injuries

Lower limb (43.0%), neck (41.2), and upper limb (39.8%) injuries were the most common types of road traffic injuries sustained by the victims admitted to the large tertiary care hospital. In addition, back, abdominal, head, and chest injuries were sustained by 28.2%, 20.5%, 20.3%, and 18.8% of the victims, respectively. Details of the anatomical sites of the traffic road injuries sustained by the victims are shown in Table 3.

Table 3.

Anatomical sites of the injury

Anatomical location of the injury	n	%
Lower limb	664	43.0
Neck	636	41.2
Upper limb	615	39.8
Back	436	28.2
Abdominal	316	20.5
Head	314	20.3
Chest	290	18.8
Pelvic	87	5.6
Burns	5	0.3
Shock	4	0.3

Associations between the variables of the victims and road traffic injuries

Chi-square/Fisher’s exact tests were used to assess the associations between the variables of the victims and the anatomical sites of the traffic road injuries. To control confounding factors and calculate the odds ratios, the variables that were significantly associated in the Chi-square tests were retained in a multivariate logistic regression model. The results of the multivariate logistic regression model are shown in Table 4.

Table 4.

Associations between variables of the victims and anatomical site of injuries

Anatomical site/variable							95% CI for aOR
		β	SE	Wald	p-value	aOR	Lower	Upper
Abdomen
Age	< 30	-0.23	0.18	1.58	0.209	0.79	0.55	1.14
	≥ 30	Reference
Seatbelt	No	0.63	0.17	13.39	< 0.001	1.88	1.34	2.63
	Yes	Reference
Back
Age	< 30	Reference
	≥ 30	0.54	0.18	8.84	0.003	1.71	1.20	2.45
Gender	Male	Reference
	Female	0.45	0.18	6.10	0.013	1.56	1.10	2.23
Seatbelt	No	0.19	0.16	1.43	0.232	1.21	0.89	1.64
	Yes	Reference
Upper limbs
Age	< 30	Reference
	≥ 30	0.18	0.11	2.49	0.114	1.20	0.96	1.50
Gender	Male	Reference
	Female	0.26	0.12	4.48	0.034	1.29	1.02	1.64
Lower limbs
Age	< 30	Reference
	≥ 30	0.12	0.16	0.53	0.466	1.12	0.82	1.53
Gender	Male	Reference
	Female	0.24	0.16	2.28	0.131	1.27	0.93	1.72
Position	Driver	Reference
	Front passenger seat	0.09	0.18	0.24	0.621	1.09	0.77	1.54
	Back passenger seat	-0.55	0.18	9.79	0.002	0.58	0.41	0.81
	Pedestrian	0.88	0.23	14.76	< 0.001	2.41	1.54	3.78
Pelvis
Age	< 30	Reference
	≥ 30	0.61	0.27	5.02	0.025	1.84	1.08	3.12
Position of the victim	Driver	Reference
	Front passenger seat	-0.22	0.36	0.37	0.542	0.80	0.40	1.62
	Back passenger seat	-0.77	0.40	3.74	0.053	0.46	0.21	1.01
	Pedestrian	0.93	0.34	7.39	0.007	2.54	1.30	4.98
Chest
Age	< 30	Reference
	≥ 30	0.46	0.21	5.12	0.024	1.59	1.06	2.38
Gender	Male	Reference
	Female	0.64	0.23	7.50	0.006	1.89	1.20	2.98
Seatbelt	No	Reference
	Yes	-0.33	0.19	2.89	0.089	0.72	0.49	1.05
Deployed airbag	No	Reference
	Yes	-0.28	0.20	1.99	0.158	0.76	0.52	1.11
Head
Age	< 30	Reference
	≥ 30	-0.20	0.18	1.17	0.280	0.82	0.57	1.18
Seatbelt	No	0.40	0.17	5.30	0.021	1.49	1.06	2.10
	Yes	Reference
Neck
Age	< 30	Reference
	≥ 30	0.93	0.21	19.68	< 0.001	2.54	1.68	3.82
Gender	Male	Reference
	Female	1.07	0.20	29.66	< 0.001	2.91	1.98	4.28
Deployed airbag	No	0.62	0.18	12.03	0.001	1.85	1.31	2.63
	Yes	Reference

aOR adjusted odds ratio, CI Confidence interval, SE Standard error

The victims who were 30 years or older were more likely to sustain back injuries (aOR = 1.71, 95% CI: 1.20–2.45) pelvic injuries (aOR = 1.84, 95% CI: 1.08–3.12), chest injuries (aOR = 1.59, 95% CI: 1.06–2.38), and neck injuries (aOR = 2.54, 95% CI: 1.68–3.82) compared to the victims who were younger than 30 years.

Female victims were more likely to sustain back injuries (aOR = 1.56, 95% CI: 1.10–2.23), upper limb injuries (aOR = 1.29, 95% CI: 1.02–1.64), chest injuries (aOR = 1.89, 95% CI: 1.20–2.98), and neck injuries (aOR = 2.91, 95% CI: 1.98–4.28) compared to male victims.

The victims who were pedestrians were more likely to sustain lower limb injuries (aOR = 2.41, 95% CI: 1.54–3.78) and pelvic injuries (aOR = 2.54, 95% CI: 1.30–4.98) and victims who were in the back passenger seat were less likely to be injured (aOR = 0.58, 95% CI: 0.41–0.81) compared to the victims who were in the driver seat.

The victims who did not use seatbelts were more likely to sustain abdominal injuries (aOR = 1.88, 95% CI: 1.34–2.63) and head injuries (aOR = 1.49, 95% CI: 1.06–2.10) compared to the victims who used seatbelts. The victims who did not have the airbag deployed were more likely (aOR = 1.85, 95% CI: 1.31–2.63) to sustain neck injuries compared to those who had the airbag deployed.

Discussion

Summary of the main findings

Despite the continuing efforts by the UN, WHO, and EU, the number of road traffic injuries and deaths continues to increase globally [2, 5, 6]. For the first time, epidemiological patterns of road traffic injuries of a large sample in a major tertiary care hospital in the West Bank of Palestine were described and associations between the variables of the victims and the anatomical positions of the road traffic injuries were also assessed. The findings showed that young adults (age range 20–30 years) and males were the most vulnerable groups to road traffic injuries. In this study, car crashes caused the vast majority of road traffic injuries. The findings also showed variabilities in the timing of the road traffic crashes that caused these injuries. The findings showed associations between age, gender, position of the victim, use of seatbelts, and deployment of airbags with certain road traffic injuries. The findings reported in this study are informative to healthcare providers in trauma centers, emergency departments, hospitals, healthcare authorities, transport authorities, and other stakeholders who might need to allocate resources to care for victims of road traffic injuries and/or design and implement measures to eliminate/minimize road traffic injuries.

Discussion and interpretation of the main findings

In this study, the majority of the victims were male, in the young adult age group (in their 20s and 30s), single, and a considerable proportion of the victims in the documented cases were drivers. In the West Bank of Palestine, the majority of drivers are men. Previous studies have reported that young men were more likely to be involved in risky driving behaviors and road traffic crash compared to women and older adults [20–25]. These findings can be explained by a lack of driving skills, speeding, driving under the influence, and being distracted while driving by smartphones [26–28]. It has been reported that men were more likely to overestimate their driving skills, underestimate the severity of physical injuries, and tend to be less concerned with the potential legal consequences of aggressive driving [20, 28, 29]. Conversely, women are generally more cautious drivers and often tend to prioritize safety [30]. Together, these findings indicate a need for measures and interventions to promote safe driving behaviors, notably to target young male drivers. These measures and interventions could include educational/training workshops and campaigns to emphasize the severe consequences of reckless driving and the enforcement of traffic laws. In addition, authorities should consider incorporating training sessions to address overconfidence in driving skills and the risks associated with multitasking while driving. These measures, interventions, and training sessions could reduce road traffic crashes, injuries, and deaths.

The findings of this study showed temporal variations in the rates of road traffic injuries over the years, months, days, and hours of the day. These variations can inform decisions to design and implement preventive interventions. The findings of this study indicated a seasonal trend of traffic road crashes between April and August (spring and summer seasons). This can be linked to more frequent travels during warmer months, the holiday season, and the peak of cultural and social events. Previous studies that were conducted elsewhere also reported peaks of traffic road crashes and injuries during seasons and periods of increased travel and outdoor activities [13, 31–33]. In addition, the hourly distribution of road traffic crashes and injuries indicated peaks during heavy traffic that can be linked to school dismissals, work commutes, and social activities. On the other hand, the early-morning and late-night peaks can be linked to factors including reduced visibility and driver fatigue [34]. The reported temporal variations in road traffic crashes and injuries might inform the timing of implementing the safety measures. Probably, authorities might need to increase the presence of law enforcement during the high-risk peak hours. This might help reduce road traffic crashes, injuries, and deaths. Moreover, improving the infrastructural and road conditions including lighting and road markings might also help reduce traffic crashes, injuries, and deaths. Furthermore, health authorities might also consider these findings to improve preparedness and allocate adequate resources to care for the victims admitted to trauma centers and emergency departments.

The anatomical sites of the road traffic injuries sustained by the victims of road traffic crashes included in this study showed a predominance of lower limb, neck, and upper limb injuries. These findings were consistent with the variability of anatomical sites reported in the previous epidemiological patterns of road traffic injuries [25, 35–38]. Together, these findings indicated the increased vulnerability of these anatomical sites during road traffic crashes [39–43]. Moreover, the findings reported in this study were consistent with the classic impact zone in traffic road crashes and positions of these anatomical sites, particularly the limbs while seated in the vehicle. Furthermore, the neck is particularly susceptible to whiplash and more severe injuries as a result of sudden collisions or stops. In addition, back, abdominal, head, and chest injuries indicated the diversity of trauma that victims of road traffic crash can sustain. Although injuries in the different anatomical sites can potentially be fatal or life-threatening, however, head injuries can be of particular importance because of the potential long-term neurological and/or cognitive impairments [44]. Moreover, chest injuries can expose the heart and lungs to serious risks. In addition, victims who sustain abdominal injuries need to be monitored for internal organ damage and/or bleeding. The patterns of road traffic injuries reported in this study indicated a need for comprehensive trauma care. Healthcare providers in trauma centers and emergency départements need to prioritize stabilizing victims of road traffic crash who could have multiple injuries in different anatomical sites. Moreover, decision-makers should consider the results reported in this study to promote the use of protective measures including seatbelts and helmets, maintaining seating positions, and monitoring vehicle safety features.

In this study, sustaining an injury in a specific anatomical site was associated with demographic and situational factors. The findings of this study indicated that older victims were more likely to sustain back, pelvic, chest, and neck injuries. Our findings might indicate the physical vulnerability of older people to sustain these injuries because of reduced muscle strength and flexibility that increase their likelihood of sustaining road traffic injuries [29, 41, 45]. These findings indicate that decision-makers, engineers, and manufacturers of vehicles should consider improving vehicle designs, headrests, and neck-support features. These measures might reduce the incidence and severity of these injuries. Moreover, females were at higher risk for back, upper limb, chest, and neck injuries. These findings could be explained by gender-based differences in the body structure and muscle mass between women and men [46, 47]. Additionally, these findings could also be explained by differences in driving behaviors and seating positions between men and women. These findings highlight a need to design appropriate measures to reduce the incidence of road traffic injuries. Moreover, the pedestrians were more likely to sustain lower limb and pelvic injuries compared to drivers and other vehicle passengers. These findings indicated the significant impact of vehicle–pedestrian collisions [6, 7, 9, 24, 25, 33, 44, 45]. These findings could be considered a call to improve the infrastructure of roads, designs of crosswalks, and launch awareness campaigns to target drivers and pedestrians. In this study, the victims who were in the back passenger seats sustained fewer traffic road injuries compared to those who were in the driver seats. These findings indicated that being in in the rear of the vehicle could partially protect passengers from sustaining traffic road injuries. These findings could be informative in formulating safety recommendations, notably those aiming at protecting vulnerable groups including children, the elderly, and those with disabilities [48, 49].

In this study, there was a significant association between not wearing seatbelts and an increased likelihood of sustaining abdominal and head injuries. These findings reinforce the importance of using seatbelts in preventing severe road traffic injuries [50, 51]. Similarly, airbag deployment can protect individuals from sustaining severe neck injuries [52]. These findings indicate the importance of using seatbelts and monitoring the functionality of airbags in saving lives and protecting against serious road traffic injuries. Authorities should continue to enforce compliance with using seatbelts and increase awareness of the importance of maintaining the functionality of airbags.

Limitations of the study

This study was conducted using a retrospective design and the data were collected from the electronic medical records system of the tertiary care hospital. Missing data is one of the main limitations of retrospective studies. In most of the healthcare systems around the world, medical records are not always complete or thoroughly detailed. This could be a call for healthcare providers and decision-makers in hospitals to improve the quality of documentation and completeness of the medical records. Moreover, the data were collected from a tertiary care hospital. This could have been associated with selection bias. Patients who sustained RTIs could have been rushed to emergency departments in nearby hospitals or care centers.

Conclusion

The epidemiological patterns of road traffic injuries in a large tertiary care hospital in the West Bank of Palestine were described and the associations between the different variables of the victims and the patterns of road traffic injuries were assessed. The findings of this study indicated that young adult males were particularly affected by traffic road injuries. There was a high incidence of lower limb, neck, and upper limb injuries. These findings indicated a need to design measures to prevent/minimize these injuries, notably among drivers and pedestrians. The increased likelihoods of back, pelvic, chest, and neck injuries among old victims and back, upper limb, chest, and neck injuries among women suggested a need for age- and sex-specific safety measures. In addition, the significant association between lower injury rates and the use of seatbelts and the deployment of airbags highlighted the importance of using these safety measures to prevent severe road traffic injuries. Future studies are still needed to determine the best measures to prevent/minimize the incidence of serious road traffic injuries.

Authors’ contributions

AR and RS were involved in the conception and design of the work, analysis and interpretation of data, and drafting and final approval of the manuscript. DS, TD, IH, and ZF were involved in the data acquisition, analysis, drafting of the work, and final approval of the version to be published. All authors approved the final manuscript.

Funding

This study did not receive any specific funding.

Data availability

All data analyzed in this study were included in the manuscript.

Declarations

Ethics approval and consent to participate

This study was conducted in adherence to the relevant international guidelines and regulations followed in scientific research involving human subjects. This study received ethical approval from the Institutional Review Board (IRB) of An-Najah National University (Protocol #: NNU-IRB-10–14). The privacy of the patients and confidentiality of the data were maintained throughout the study. The data collected in this study were coded. Because this study was based on the medical records of the victims of road traffic injuries, written informed consent from the victims was waived by the IRB of An-Najah National University.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.