Trauma is a significant cause of morbidity and mortality worldwide, ranking among the top three causes of death in individuals aged 1–45 years. In India, the trauma burden is disproportionately high due to a combination of rapid urbanization, poor infrastructure, weak enforcement of safety laws, and a fragmented healthcare and forensic system. The World Health Organization has emphasized the urgent need to address trauma as a global epidemic [1].

India, as a low-to-middle income country (LMIC), faces unique challenges in trauma prevention and management. RTAs alone account for nearly 10% of global road fatalities, and India has the highest number of road deaths globally [2]. Furthermore, underreporting of trauma-related deaths, especially in rural and under-resourced areas, obscures the true magnitude of the problem.

This systematic review synthesizes current literature on trauma-related deaths in India, highlighting state-wise variations, patterns of causation, and the vital role of forensic medicine in accurate death certification, medico-legal investigations, and policy advocacy.

A systematic review was undertaken following PRISMA guidelines. Searches were conducted in PubMed, Scopus, and Google Scholar using keywords such as “trauma-related deaths India,” “road traffic accidents,” “suicide mortality,” “homicide in India,” and “forensic autopsy trauma.” Government reports, including NCRB and MoRTH annual datasets (2010–2024), were also examined.

Inclusion Criteria: - Original research studies and national/state datasets (2010–2024) - English-language studies - Indian population-based trauma mortality data - Studies with autopsy or forensic evaluation of trauma

Exclusion Criteria: - Case reports, narrative reviews - Editorials and commentaries without empirical data

Data Extraction and Synthesis: Key variables extracted included geographic location, age, sex, mechanism of trauma, manner of death (accidental, suicidal, homicidal), injury characteristics, and forensic autopsy findings. Comparative tables and visual data (pie charts, flow diagrams) were used to analyze state-wise and cause-wise differences.

Figure 1: PRISMA Flowchart of Study Selection

Major Causes of Trauma-Related Deaths

India’s trauma landscape is diverse. RTAs dominate due to the exponential rise in motorization, poor road engineering, and inadequate enforcement of traffic safety laws. Suicides are the second most common cause, especially in southern states, where pesticide ingestion and hanging are prevalent. Homicides, though less frequent, present serious medicolegal concerns in urban and conflict-prone zones. Occupational injuries and falls are commonly seen in marginalized communities and aging populations, respectively.

Table 1: Major Categories of Trauma in India

Table 2: Comparative State-wise Distribution of Trauma-related Deaths (2022)

Sources: NCRB Crime in India 2022; MoRTH Road Accident Report 2022

Figure 2: Pie chart showing Proportion of Major Trauma Causes in National Context

Forensic Implications

Medico-Legal Autopsy: Despite being mandated for unnatural deaths, medico-legal autopsies are inconsistently practiced across India. High-burden states report backlogs and poor documentation. Uniform autopsy protocols can improve quality and legal utility.

Documentation and Reporting: Tools such as the Injury Severity Score (ISS) and Abbreviated Injury Scale (AIS) are underused. Many postmortem reports lack standardized injury diagrams and histopathological correlation.

Postmortem Interval Estimation: Forensic techniques such as histology, rigor mortis evaluation, and entomology are essential for determining time since death—crucial for criminal investigations—but are inconsistently applied

Our review reveals that trauma mortality in India is driven by systemic inefficiencies. In Uttar Pradesh and Madhya Pradesh, high RTA and homicide rates reflect infrastructural and law enforcement deficiencies. Maharashtra and Tamil Nadu, though more urbanized, also report significant trauma burdens, highlighting that urbanization alone does not mitigate risk.

In contrast, Kerala demonstrates high suicide rates but low homicide deaths, suggesting socio-cultural and mental health trends play an important role. The variation in occupational injuries across industrialized states underlines the need for robust workplace safety legislation.

Internationally, India’s trauma burden is comparable to other LMICs like Brazil and South Africa, though data integration and trauma registry implementation remain more advanced abroad. Forensic pathology in India must evolve from a procedural necessity to a robust analytical tool to support public health and criminal justice.

Limitations –

Variability in study design and quality across regions - Underrepresentation of northeastern and tribal regions - Lack of centralized trauma registry hampers real-time analysis - Bias due to reliance on secondary data sources

Recommendations –

Create and mandate a national trauma registry with forensic integration - Train medical officers and forensic pathologists in standard autopsy protocols - Link forensic and police databases to improve trauma surveillance - Promote research into state-specific trauma trends for tailored interventions

Trauma-related deaths in India highlight glaring gaps in public health policy, infrastructure, and forensic science. While causes like RTAs and suicides dominate, each trauma category reflects broader social, cultural, and legal factors. A multidisciplinary, evidence-driven strategy is needed to reduce mortality, improve forensic accountability, and protect vulnerable populations.

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3. National Crime Records Bureau. Crime in India 2022. Ministry of Home Affairs, Government of India.
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