Tri-modal Distribution of Trauma Deaths in a Resource-Limited Setting: Perception Versus Reality

Area of Science:

• Public Health
• Trauma Surgery
• Epidemiology

Background:

• Trauma mortality patterns differ between high-income and low-to-middle-income countries.
• The classical trimodal death pattern is less evident in high-income nations due to advances in trauma care.
• Data on temporal trauma death patterns in sub-Saharan Africa are scarce.

Purpose of the Study:

• To evaluate the temporal epidemiology of trauma deaths in Malawi.
• To identify predictors of early versus late mortality in trauma patients.
• To inform strategies for improving trauma care outcomes in the region.

Main Methods:

• Retrospective analysis of trauma registry data from Kamuzu Central Hospital, Malawi (2009-2021).
• Comparison of patient outcomes based on timing of death relative to injury.
• Modified Poisson regression used to identify predictors of early mortality.

Main Results:

• Overall mortality was 2.4% (4,096/165,324 patients).
• The majority of deaths occurred pre-hospital (56.9%) or in the emergency department (15.1%).
• Early death was linked to non-ambulance transport, vehicle trauma, and penetrating injuries; ambulance use reduced early death risk by 40%.

Conclusions:

• Most trauma deaths in this Malawian tertiary center occur within 48 hours of injury, predominantly pre-hospital.
• Significant investment in pre-hospital care, including first-responder training and EMS infrastructure, is essential.
• Addressing pre-hospital care gaps is critical for improving trauma patient outcomes in sub-Saharan Africa.