Crashes involving motorised rickshaws in urban India: Characteristics and injury patterns

INTRODUCTION: Motorised three-wheeled vehicles (motorised rickshaw) are popular in Asian countries including India. This study aims to describe the crash characteristics and injury patterns for motorised rickshaw occupants and the road users hit-by-motorised rickshaw in urban India. METHODS: Consecutive cases of road traffic crashes involving motorised rickshaw, irrespective of injury severity, whether alive or dead, presenting to the emergency departments of two large government hospitals and three branches of a private hospital in Hyderabad city were recruited. Crash characteristics, details of injuries, injury severity parameters and outcome were documented in detailed interviews. RESULTS: A total of 139 (18%) of the 781 participants recruited were injured as a motorised rickshaw occupant (11%) or were hit by a motorised rickshaw (7%) in 114 crashes involving motorised rickshaw. Amongst motorised rickshaw occupants, single-vehicle collisions (54%) were more frequent than multi-vehicle collisions (46%), with overturning of motorised rickshaw in 73% of the single-vehicle collisions. Mortality (12%), the mean Injury Severity Score (5.8) and rate of multiple injured (60%) indicated a substantial trauma load. No significant differences in injury pattern were found between motorised rickshaw occupants and hit-by-motorised rickshaw subjects, with the pattern being similar to that of the pedestrians and two-wheeled vehicle users. With bivariate analysis for motorised rickshaw occupants, the risk of fatal outcome (odds ratio (OR) 2.60, 95% confidence interval (CI): 0.64–10.54), upper limb injury (OR 2.25, 95% CI: 0.94–5.37) and multiple injuries (OR 2.03, 95% CI 0.85–4.83) was high, although not statistically significant in multi-motorised-vehicle collisions as compared with the single-vehicle collisions or overturning. The risk of having multiple injuries (OR 4.55, 95% CI: 1.15–17.95) was significantly higher in motorised rickshaw occupants involved in front collisions. Being a front-seat motorised rickshaw passenger in a vehicle collision increased the risk of having a fatal outcome (OR 7.37, 95% CI: 0.83–65.66) and a Glasgow coma score ≤ 12 (OR 2.21, 95% CI: 0.49–9.89), although not significantly when compared to the back-seat passengers. CONCLUSION: These findings can assist with planning to deal with the consequences and prevention of road traffic injuries due to crashes involving motorised rickshaw, given the high use of these and substantial morbidity of related injuries in India. The need for improved understanding of the risk characteristics of motorised rickshaw is highlighted.