This study aims to describe patterns of injury mechanism among patients treated at a tertiary trauma center in Mumbai to identify opportunities for targeted injury prevention strategies. Data were collected from an institutional trauma registry, and all patients presenting with life- or limb-threatening injuries over a 16- month period were included. Univariate and bivariate analyses were performed for demographic characteristics, injury mechanisms, and clinical outcomes. A total of 1,115 patients were treated during the study period, and the in-hospital mortality rate was 32% in this severely injured cohort. More than one half of patients were suffered transportation injuries (58%). Of victims of transportation injuries, 45% were victims of railway injuries and 28% were pedestrians struck by motor vehicles. Mortality was highest among victims of railway injuries (42%) and pedestrians struck by automobiles (38%). Although injury prevention is a major public health concern worldwide, it is important to understand local patterns of injury to guide targeted prevention strategies. This study highlights the utility of trauma registries in collecting crucial injury surveillance data. In this context, a focus on pedestrian safety and railway injury prevention is warranted.