Exploring factors contributing to road traffic injury mortality across the trauma care continuum: a qualitative study

Road traffic injuries (RTIs) are a major cause of premature mortality, particularly in low- and middle-income countries. Although injury severity is a key determinant of outcomes, delays and deficiencies across the trauma care continuum may also contribute to mortality. However, less is known about these interacting factors from the perspective of professionals involved in RTIs prevention and care. This study explored experts’ perspectives on factors contributing to RTI-related mortality across prehospital and hospital care. We conducted a qualitative study using conventional content analysis. 21 experts in emergency medicine, trauma surgery, prehospital emergency medical services (EMS), orthopedic surgery, nursing, and health management were recruited using purposive sampling with maximum variation and supplemented by snowball sampling. Participants had direct professional involvement in RTI prevention, emergency response, trauma care, or health-system management. Data were collected through semi-structured, in-depth interviews and analyzed concurrently with data collection. Interviews continued until conceptual saturation was reached. Data were analyzed using conventional content analysis based on the approach described by Graneheim and Lundman, involving systematic identification, condensation, abstraction, and categorization of meaning units. Analysis of interviews with 21 experts generated five main categories and 21 subcategories describing interacting contributors to RTI-related mortality across the trauma care continuum. These included: (1) victim-, incident-, and injury-related factors, encompassing individual vulnerability, baseline health, social, economic, and behavioral characteristics, bystander responses, crash circumstances, and injury severity; (2) deficiencies in prehospital response and care, including weaknesses in emergency activation and dispatch, delayed access, resource limitations, inadequate scene assessment and triage, and insufficient life-saving interventions; (3) disruptions in transport, referral, and continuity of care, including inappropriate destination selection, ineffective interhospital transfer, poor communication and handover, and fragmented care transitions; (4) deficiencies in hospital trauma care, including structural and resource constraints, inadequate emergency department triage and response, delays in diagnosis and clinical decision-making, and secondary deterioration or hospital-acquired complications; and (5) weaknesses in trauma-system governance, quality, safety, and equity, including patient-safety failures, inadequate mortality surveillance and review, limited policy and standardization, and inequitable access to specialized trauma services. Collectively, experts described mortality as a multidimensional outcome arising from the interaction of patient and injury characteristics with delays, care gaps, coordination failures, and system-level weaknesses across successive stages of trauma care. RTI-related mortality may be influenced by modifiable gaps throughout the trauma care continuum. Strengthening prehospital response, referral and continuity of care, hospital trauma services, and trauma-system governance may help reduce avoidable mortality, particularly in resource-constrained settings. Not applicable.