Road traffic injuries in Kandy District, Sri Lanka: a prospective analysis of trauma and disability at a tertiary care center

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.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s12245-026-01349-0.

Background

Road traffic injuries (RTIs) represent a major and growing public health crisis globally, with disproportionate impacts in low- and middle-income countries (LMICs). The World Health Organization (WHO) ranks RTIs as the eighth leading cause of death worldwide and the leading cause of death among individuals aged 5–29 years [1]. While LMICs account for just 60% of the world’s registered vehicles, they experience over 90% of global road traffic deaths [1]. The societal burden is equally staggering – RTIs are one of the leading causes of disability-adjusted life years (DALYs) lost globally, a metric often used to estimate economic and productivity loss [2]. Globally, RTIs are a leading cause of disability among individuals aged 25–49, critical years for economic productivity [3].

Sri Lanka, an LMIC with a population of approximately 22 million, has made remarkable strides in public health. The country boasts a maternal mortality ratio of 18 deaths per 100,000 live births [4], a neonatal mortality rate of 4 per 1,000 live births [5], and a life expectancy of 77.6 years [6]. These outcomes exceed regional benchmarks and, in several domains, are comparable to those of high-income countries [7]. However, trauma remains a critical gap in this otherwise high-performing system, with RTIs representing one of the most significant and persistent contributors. Sri Lanka has the highest estimated rate of road traffic deaths per capita among its immediate South Asian neighbors and a fatality rate that is five times higher than in the best-performing countries globally [8]. Road traffic crashes in Sri Lanka result in over 3,000 deaths and 8,000 serious injuries annually, killing an estimated nine people each day [9]. Vehicle ownership in Sri Lanka is already high relative to the region and grew by 67% between 2011 and 2018. If this trajectory continues, road crash injuries and fatalities are likely to rise further unless safety reforms and infrastructure improvements are implemented [8]. Reducing road traffic fatalities could yield significant economic returns; one World Bank analysis estimates that a 10% reduction in crash deaths in countries like Sri Lanka could increase GDP by an additional 3.6% over a 24-year period [10].

In recent years, Sri Lanka has made meaningful strides in emergency response through the launch of the 1990 Suwa Seriya Ambulance Service in 2016, which provides free, government-supported prehospital care across the country. Utilization of ambulance transport remains limited; in a study of injury patients admitted to a tertiary trauma center in southern Sri Lanka, only 20.5% used an ambulance to reach the first health facility, while over half arrived via three-wheeler or private vehicle [11]. Many injured individuals rely instead on informal transport, such as private vehicles or three-wheelers, leading to delays in care. Moreover, critical components of a robust trauma system—such as a national trauma registry, standardized trauma center designation, and coordinated regional infrastructure—remain underdeveloped.

Although some areas of Sri Lanka have received targeted investment in trauma care, much of the research on RTIs has been retrospective and geographically limited, often centered around Colombo, the nation’s capital and largest city. This limits generalizability to regions with distinct topography, infrastructure, and access to care. Kandy, a district located in Sri Lanka’s central highlands, is one such region. Despite its population of over 1.5 million and the presence of major referral hospitals, the district has not previously been the focus of many prospective trauma studies [12].

This study, conducted in the Kandy District, focuses on patients treated at National Hospital Kandy. Given the region’s complex topography, dense traffic, and mixed urban-rural population, access to timely trauma care remains a persistent challenge. Using a prospective design, this study presents a detailed epidemiological profile of RTI patients, including demographic characteristics, types of injuries sustained, and anatomical sites of trauma. In addition, it captures short-term disability outcomes at discharge and at follow-up intervals. By describing 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, this study aims to inform trauma care delivery and future surveillance efforts in regions of Sri Lanka outside the capital.

Methods

Aims

The aim of this study was 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 care hospital in Sri Lanka’s Central Province.

Study design and setting

We conducted a prospective observational study at National Hospital Kandy (NHK), the largest tertiary referral center in Sri Lanka’s Central Province. Enrollment occurred over a seven-month period from March to September 2024, corresponding to the funded study period and spanning both dry- and wet-season months. NHK has 2,741 beds and provides continuous specialized care across medical, surgical, maternal, diagnostic, emergency, and rehabilitative services. The hospital includes 75 inpatient wards, 12 ICUs (65 beds), 11 operating theaters (38 beds), and 52 specialty clinics. Annually, NHK admits over 238,000 inpatients, treats one million clinic patients, and manages approximately 400,000 outpatient visits. It also performs more than 66,000 surgeries and 9,000 deliveries each year [13].

NHK serves as the primary referral center for moderate- to high-acuity trauma from across Kandy District and neighboring areas. However, it is not the only facility treating road traffic injury (RTI) patients in the region; several other hospitals – including Teaching Hospital Peradeniya – also evaluate and manage RTI cases.

Data collection occurred in the Emergency Treatment Unit (ETU) and inpatient wards. All patients presenting to NHK for injuries sustained in road traffic incidents were eligible for inclusion, including those discharged directly from the ETU after evaluation. Written informed consent was obtained from all participants prior to enrollment. For patients unable to provide consent themselves because of injury severity, written informed consent was sought from an accompanying family member or legal guardian; patients were excluded only when neither the patient nor a surrogate could provide consent.

Study population

Eligibility and consent procedures are described above under Study Design and Setting. The cohort included both patients admitted to inpatient wards and those discharged directly from the ETU.

Data collection

Trained research assistants were present across the Emergency Treatment Unit and inpatient wards and identified eligible patients through direct screening of new arrivals and in coordination with clinical staff. Once identified, patients were approached for consent and administered structured interviews and bedside chart reviews using a standardized data collection form developed for this study. Data collection instruments were administered in English, Sinhalese, or Tamil using REDCap on tablet devices. In instances where tablet use was not feasible, paper-based forms were used and later transcribed into REDCap. The study-specific questionnaire is provided in English in the Supplementary Materials (Supplementary File: Questionnaire).

Collected data included sociodemographic characteristics (age, sex, ethnicity, religion, education, and occupation); crash and exposure details (type of road user, vehicle involved, safety equipment use, and substance use); transport and access to care (mode of arrival, number of facilities visited, and delays); and clinical variables. Functional disability outcomes were assessed at discharge and at three and six weeks post-injury via telephone follow-up.

Follow-Up

Participants were contacted by phone at three and six weeks following discharge. Follow-up calls assessed changes in functional disability and the financial impact of the RTI using a standardized follow-up questionnaire developed for this study (Supplementary File: Questionnaire). Functional disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), which evaluates functioning across six domains: cognition, mobility, self-care, getting along with others, life activities, and participation in society. Each item was scored on a 5-point Likert scale ranging from 1 (no difficulty) to 5 (extreme difficulty or cannot do). A simple scoring method was used, whereby item scores were summed to generate a total score ranging from 12 to 60, with higher scores indicating greater disability [14]. Data from follow-up encounters were recorded in REDCap. In-hospital deaths occurred during the study period; however, disposition and mortality outcomes were inconsistently documented in the paper-based clinical record and could not be reliably ascertained. Enrolled participants therefore represent predominantly survivors of road traffic injury, and in-hospital mortality is not reported.

Trauma severity

Trauma severity was assessed using the Kampala Trauma Score (KTS), a composite measure based on systolic blood pressure, respiratory rate, neurological status, and number of serious injuries. The KTS defines the number of serious injuries as the number of body regions with injuries considered clinically significant based on established scoring criteria [15]. KTS was calculated from the first vital signs and neurological assessment recorded at NHK; for patients transferred from another facility, these reflected the initial NHK presentation rather than pre-transfer values.

Data analysis

We conducted descriptive analyses to characterize the study cohort at the time of initial hospitalization. Categorical variables are presented as counts and percentages, while continuous variables are reported as means (SDs) and medians (IQRs). Key demographic and clinical characteristics were visualized as bar-charts. Functional disability outcomes were compared at discharge, 3-week and 6-week and visualized with Box plot. All analysis was performed in R statistical programming languages, version 4.5.1.

Ethics

This study was approved by the Stanford University School of Medicine Institutional Review Board (IRB #71107) and the Research & Ethical Review Committee of the National Hospital, Kandy (NHK/ERC/108/2023). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants prior to enrollment. No waivers of consent were granted by either ethics committee.

Results

Patient demographics

A total of 567 patients who sustained road traffic injuries (RTIs) were enrolled in the study. The mean age was 37.8 years (SD 16.8), with a median age of 34 years (range: 6–83) (Fig. 1). The majority of patients were male (77.1%, n = 437); gender data were missing for three patients (0.5%).

Fig. 1.

Estimated age distribution of RTI patients at National Hospital Kandy (N = 567)

Most participants identified as Sinhala (84.0%), followed by Sri Lankan Moor (10.6%), Tamil (5.1%), and Malay (0.2%); ethnicity data were missing for one patient. Religious affiliation mirrored these patterns, with the majority identifying as Buddhist (82.4%), followed by Islam (10.6%), Hindu (4.6%), Roman Catholic (1.4%), and other Christian Sect.  (0.5%).

Among the cohort, the most common level of education was the Advanced Level (A/L) certificate, which students finish at approximately 18 years of age, (43.9%), followed by the Ordinary Level (O/L) certificate, which students finish at approximately 16 years of age, (31.4%) and below O/L (18.0%). Only 6.2% of patients held a university degree. Occupation data were missing for 23.3% of patients, however, among those with available data, the most frequently reported employment categories were unemployed (19.2%), service and sales workers (19.4%), and professionals (12.3%).

Injury characteristics

Among all participants, 91.5% (n = 519) sustained injury to at least one anatomical site. Across the 519 injured patients, 840 injured body regions were recorded, a mean of 1.6 per patient, indicating that many patients sustained injuries to more than one region. The remaining 8.5% (n = 48) had no anatomical injury site recorded, reflecting patients evaluated after a road traffic incident in whom no injury was documented rather than missing data. The most commonly affected regions were the lower extremities (56.1%) and upper extremities (50.6%), followed by head injuries (25.4%). Injuries to the chest (8.5%), abdomen (3.7%), pelvis (1.4%), neck (1.4%), and other anatomical sites (1.1%) were less frequent (Fig. 2).

Fig. 2.

Frequency of injury by anatomical site among patients presenting with road traffic injuries at National Hospital Kandy (N = 567). Note: patients may present with injuries at multiple anatomical sites; thus, categories are not mutually exclusive and one patient may be represented in multiple bars

Road user type

The most common type of road user was motorcycle drivers (37.1%), followed by pedestrians (16.2%), motorcycle passengers (11.9%), and three-wheeler passengers (10.5%). Other groups included three-wheeler drivers (6.5%), scooter drivers (5.9%), auto or vehicle drivers (4.1%), and auto or vehicle passengers (4.0%). A small number of cases involved pedal cyclists (1.1%) or pedal cycle passengers (1.1%), and 0.4% of cases were missing data. This distribution highlights the vulnerability of motorcyclists and pedestrians in Sri Lanka’s current road environment (Fig. 3).

Fig. 3.

Distribution of road user types among patients presenting with road traffic injuries at national Hospital kandy

Trauma severity

The mean KTS was 8.29 (SD 1.38), with a median of 9.0 (range: 4–10). Most patients were classified as having mild injuries (KTS ≥ 9) (61.6%), followed by moderate (KTS 7–8) (22.0%) and severe (KTS ≤ 6) (14.8%) trauma. KTS data were missing for 1.6% of the sample (Fig. 4).

Fig. 4.

Distribution of trauma severity based on the Kampala Trauma Score among patients with road traffic injuries at National Hospital Kandy

Mode of transport to hospital

The most common mode of transport to the hospital was ambulance (48.3%), followed by three-wheelers (31.0%) and private cars (7.6%). An additional 12.3% of patients arrived by other types of vehicles, while transport mode was unknown or missing for four patients (Fig. 5).

Fig. 5.

Modes of transport used by road traffic injury patients to reach National Hospital Kandy

Functional disability outcomes

Disability scores were assessed at discharge, 3 weeks, and 6 weeks post-injury. At discharge, the mean disability score was 19.9 (SD 8.47), with a median of 18.0 (range: 10–50); however, 36.7% of these data were missing. Disability scores were available for 359 patients at discharge, 238 at 3 weeks, and 175 at 6 weeks. By week 3, the mean score had declined to 15.0 (SD 7.91), with a median of 10.0 (range: 10–45), though missingness increased to 58.0%. At week 6, disability further declined to a mean of 14.0 (SD 7.51), median 10.0 (range: 10–46), with 69.1% of data missing (Fig. 6).

Fig. 6.

Mean total disability scores at discharge, week 3, and week 6 among RTI patients at National Hospital Kandy

Discussion

Demographics

This prospective study of 567 patients at the National Hospital Kandy provides valuable insight into the demographic and clinical characteristics of RTI patients in Sri Lanka. The majority of patients were young adult males, consistent with national and global findings on the gendered burden of trauma [16]. This demographic profile closely mirrors other Sri Lankan hospital-based trauma series: a two-month case series of 473 road traffic trauma admissions at Colombo South Teaching Hospital reported a mean age of 37.2 years and 70.2% male [17], and earlier tertiary-care series have similarly described a predominance of young working-age men [18]. The consistency of this pattern across regions of the country reinforces that road traffic injury in Sri Lanka disproportionately affects the economically active population. The mean age in our cohort was 37.8 years (median: 34), indicating that the majority of patients were within the working-age population. This highlights a critical intersection between age, economic productivity, and injury risk. Nearly 20% of participants were unemployed, and when compared to the national unemployment rate of 4.7% in 2023 [19], this points to the economic vulnerability of those most affected by road traffic trauma.

Educational attainment among patients was concentrated at the secondary level, with most individuals holding either an Ordinary Level (O/L) or Advanced Level (A/L) certificate. Only a small proportion of patients had completed university education. This distribution is generally consistent with national education trends—only 21% of Sri Lankans of tertiary education age are enrolled in postsecondary institutions [20]. However, among the working-age population, lower educational attainment is often associated with employment in high-risk occupations such as manual labor or commercial driving. This may help explain why individuals with less formal education were highly represented among RTI patients in our sample.

Injury patterns

Injury patterns in our cohort were dominated by trauma to the lower and upper extremities, followed by head injuries. This distribution is consistent with studies from other LMICs where vulnerable road users—such as motorcyclists, pedestrians, and three-wheeler passengers—make up a significant proportion of trauma cases. In our study, 37.1% of patients were motorcycle drivers, with an additional 11.9% riding as motorcycle passengers. Pedestrians accounted for 16.2% of the sample, and three-wheeler passengers represented 10.5%.

Extremity injuries, while often nonfatal, are particularly burdensome in settings like Sri Lanka where a large share of the workforce is employed in physically demanding or informal-sector jobs. In these contexts, even moderate orthopedic injuries can lead to extended periods of work incapacity, especially where access to rehabilitation services such as physical therapy is limited or financially inaccessible [21]. For patients without employment protections or disability benefits, this may result in income disruption or prolonged economic strain. At a broader level, road traffic injuries may contribute to household financial stress, particularly among working-age adults.

In our study, the average KTS was 8.29, suggesting a moderate overall level of injury severity. The majority of patients were classified as having mild injuries (KTS ≥ 9; 61.6%), followed by moderate (KTS 7–8; 22.0%) and severe trauma (KTS ≤ 6; 14.8%). These findings are broadly comparable to data from other LMICs. For example, a study conducted in Tanzania reported that 56.1% of road traffic crash victims sustained moderate injuries (KTS 7–8) and 38.6% had severe injuries (KTS ≤ 6), with only a small fraction having mild trauma (KTS ≥ 9) [22]. Compared to that setting, the distribution in our Sri Lankan cohort reflects a larger proportion of mild trauma and fewer severe cases, which may relate to differences in referral patterns, prehospital access, or injury mechanisms.

These data provide context for the range of injury severity encountered at a major referral center in Central Province. However, the Colombo South Teaching Hospital series reported an in-hospital fatality rate of approximately 3% among admitted road traffic trauma patients, with vulnerable road users accounting for the large majority of deaths and major injuries [18]. Because in-hospital deaths were not reliably captured in our cohort, our sample reflects predominantly survivors, and the true burden of severe injury is likely underestimated relative to series that ascertained mortality.

Emergency medical transport

Transport mode and referral patterns observed in this cohort provide insight into how patients accessed tertiary care. Many patients were transported by informal means, including private vehicles and three-wheelers,which do not provide prehospital medical interventions. These findings are consistent with regional studies showing that trauma patients in LMICs often have inconsistent access to prehospital care, which has been attributed to additional deaths outside of the definitive care setting [23].

Disability

While mean disability scores declined from discharge to six-week follow-up—suggesting functional improvement over time—interpretation is limited by substantial loss to follow-up, with more than two-thirds of data missing at the six-week time point. As such, the extent and duration of disability after injury remain uncertain for a large proportion of patients. However, among those reached, a notable number continued to experience measurable disability. This is concerning given evidence that individuals with disabilities in LMICs earn substantially less than their able-bodied counterparts and that households with disabled members face higher rates of multidimensional poverty [24, 25].

Limitations

This study has several limitations. First, data were collected at a single tertiary care hospital, which may limit generalizability to other regions or levels of care in Sri Lanka. Second, although enrollment was prospective, case identification relied on research staff presence across multiple clinical entry points within the hospital. As patients may arrive through different units—including the Emergency Treatment Unit, outpatient services, or direct ward admission—some cases may not have been captured.

Notably, these challenges arose despite the presence of a highly trained and dedicated local data collection team working substantial hours across clinical areas, and collaborating closely with the hospital-based care teams. This underscores not only the inherent difficulty of capturing trauma data within Sri Lanka’s current hospital infrastructure, but also the broader challenge faced by many LMICs: the lack of standardized, systematized methods for clinical data collection. These findings underscore the need for strengthened clinical information systems and, ultimately, a functioning trauma registry to support quality care and policy planning.

Third, chart review was often impeded by inconsistencies in documentation. Patient data were frequently spread across multiple parts of the chart without standardization, and handwritten notes presented significant legibility issues. Once a patient’s paper chart left the clinical area after a patient was discharged, it became extremely difficult to access for follow-up or retrospective review.

Fourth, the cohort predominantly reflects patients who survived to and through hospital care, as disposition and in-hospital mortality were inconsistently documented in the clinical record. As a result, injury severity and outcomes describe this survivor population rather than the full spectrum of injuries at presentation. These data nonetheless characterize the patients who go on to live with the consequences of road traffic injury and to draw on rehabilitation and health-system resources.

Despite these limitations, this study provides prospective data on the demographic, clinical, and functional characteristics of RTI patients presenting to a major tertiary center in Sri Lanka. The findings contribute to the limited body of prospective trauma data from regions outside the capital and offer a descriptive profile of injury patterns, severity, transport pathways, and early functional outcomes within this setting. These data may serve as a reference point for future research and for ongoing efforts to strengthen trauma surveillance and care delivery in similar contexts.

Further research is needed to better understand longer-term disability trajectories, the economic consequences of RTIs, and patterns of care across referral networks in Sri Lanka. Multi-center surveillance across hospitals within Kandy District would allow more complete estimation of injury burden, referral pathways, and system-level variation in access to care—metrics that extend beyond the scope of a single-center study.

Findings from this cohort also raise important considerations regarding prehospital transport and referral patterns. Although Sri Lanka has made substantial progress through expansion of the 1990 Suwa Seriya Ambulance Service, variation in transport modes and multi-step referral pathways remain common. Continued evaluation of triage processes, destination patterns, and transport utilization may help clarify opportunities to optimize timely access to definitive trauma care.

P hased trauma data systems have demonstrated feasibility in other LMIC settings [26–29]. Experiences from Karachi and Uganda suggest that structured, context-appropriate surveillance platforms can improve case capture and generate meaningful quality indicators. Adapting similar models to the Sri Lankan context—beginning with strengthened documentation at tertiary centers—may support ongoing efforts to improve trauma care coordination and longitudinal outcome tracking.

Conclusions

In this prospective cohort of 567 road traffic injury patients at a tertiary hospital in Sri Lanka’s Central Province, the burden fell disproportionately on working-age males, and vulnerable road users — motorcyclists, pedestrians, and three-wheeler occupants — accounted for most injuries. Injuries most often involved the extremities and head, and while the majority of patients sustained mild trauma by Kampala Trauma Score, a meaningful proportion presented with severe injury. Functional disability was common at discharge and improved over early follow-up.

These descriptive data help address the limited prospective trauma literature from regions of Sri Lanka outside the capital. They may serve as a reference point for the trauma patterns and documentation challenges encountered at a major referral center in this setting, and for future multi-center efforts to capture injury burden more completely.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

RTIs

Road Traffic Injuries

LMICs

Low- and Middle-Income Countries

WHO

World Health Organization

DALYs

Disability-Adjusted Life Years

NHK

National Hospital Kandy

RTI

Road Traffic Injury

ETU

Emergency Treatment Unit

IRB

Institutional Review Board

ICU

Intensive Care Unit

OPD

Outpatient Department

REDCap

Research Electronic Data Capture

WHODAS 2.0

World Health Organization Disability Assessment Schedule 2.0

KTS

Kampala Trauma Score

SD

Standard Deviation

IQR

Interquartile Range

A/L

Advanced Level

O/L

Ordinary Level

DOA

Dead on Arrival

Biographies

Owen Ramberg

is a medical student at the Stanford University School of Medicine. His interests include emergency medicine, global health, prehospital care, and health systems innovation.

Peter Acker

is a Clinical Associate Professor in the Department of Emergency Medicine at the Stanford University School of Medicine. His global health work focuses on strengthening emergency referral systems and prehospital care delivery in low-resource settings. He has worked extensively with ambulance and referral systems in India, Cambodia, Nepal, Uganda, and Myanmar.

Angelica Pritchard

is a Senior Clinical Research Coordinator in the Department of Emergency Medicine at Stanford University School of Medicine with extensive experience in global emergency medicine research, including data management, study operations, and clinical research training across multiple LMIC settings.

Marisa Smith

is a Global Emergency Medicine fellow and Clinical Instructor in the Department of Emergency Medicine at Stanford University School of Medicine. Her work focuses on emergency care systems strengthening, prehospital trauma training, and global emergency medicine education.

Timothy Batchelor

is an Assistant Professor of Emergency Medicine at the Stanford University School of Medicine with fellowship training in Global Emergency Medicine and Advanced Emergency Ultrasound. His research focuses on point-of-care ultrasound education and implementation in resource-limited and austere settings.

Patrick Lanter

is an Assistant Professor of Emergency Medicine at the Stanford University School of Medicine with fellowship training in Global Emergency Medicine and Ultrasound. His work focuses on sustainable ultrasound education programs in low-resource settings and emergency medicine education.

Samath Dharmaratne

is Chair Professor of Community Medicine at the Faculty of Medicine, University of Peradeniya, and Director of the Postgraduate Institute of Medical Sciences. He is an Affiliate Associate Professor at the Institute of Health Metrics and Evaluation at the University of Washington and has extensive expertise in road injury prevention and global injury surveillance.

Author contributions

OR, PA, and SD jointly conceived the study and led study design, data collection, analysis, and manuscript drafting. BG contributed to data analysis and interpretation. IYW assisted with data management and analysis. AP contributed to data collection and manuscript review, developed data collection tools, and provided administrative support. MS, TB, PL, and PA provided clinical oversight, contributed to study design, supported development of data extraction and analysis approaches, and critically revised the manuscript. NS and SD directed local study implementation and collaborative efforts, contributed substantially to study design, provided oversight of data collection, guided contextual interpretation of findings, and advised on priorities relevant to the local health system. All authors read and approved the final manuscript.

Funding

This work was supported by a Seed Grant from the Stanford University Center for Innovation in Global Health (Programs in Seed Grants) for the project “Characterizing road traffic injuries and their associated healthcare and financial burdens in Kandy District, Sri Lanka.” The total award amount was USD 43,530 and was granted to PA (Peter Acker), SD (Samath Dharmaratne), and IDZ (Ishan De Zoysa). The funders had no role in study design; data collection, analysis, or interpretation; the decision to publish; or preparation of the manuscript.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to the inclusion of potentially identifiable patient information but are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was approved by the Stanford University School of Medicine Institutional Review Board (IRB #71107) and the Research & Ethical Review Committee of the National Hospital, Kandy (NHK/ERC/108/2023). Written informed consent was obtained from all adult participants prior to enrollment. For participants under 18 years of age, written informed consent was obtained from a parent or legal guardian. No waivers of consent were granted by either ethics committee.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.