Bimodal, But Not the Same: Persistent Late Peaks in Trauma Mortality.

Area of Science:

• Trauma care research
• Public health in low- and middle-income countries (LMICs)
• Epidemiology of injury

Background:

• Trauma is a major cause of death globally, with LMICs disproportionately affected.
• High-income countries (HICs) have shifted from a trimodal to a bimodal trauma mortality distribution.
• Trauma mortality patterns in LMICs remain poorly understood.

Purpose of the Study:

• To characterize the temporal distribution of in-patient trauma deaths in Pakistan.
• To identify predictors of early (<48 hours) and late (>48 hours) mortality in adult trauma patients.
• To compare trauma mortality patterns in Pakistan with those observed in HICs.

Main Methods:

• Prospective data collection from a trauma registry in Karachi, Pakistan (December 2021-February 2023).
• Inclusion of adult patients (≥18 years) admitted directly, excluding referred cases.
• Analysis of demographics, injury severity scores (ISS), in-hospital care, and outcomes, using multivariable Cox-regression for mortality predictors.

Main Results:

• 1596 patients were analyzed; 18.36% died. Road traffic crashes and head injuries were primary causes.
• Mortality was equally distributed between early (<48 hours) and later (days 2-7) periods, with a smaller peak after 7 days.
• Increased Injury Severity Score (ISS) predicted early mortality; comorbidities and head injury predicted late mortality.

Conclusions:

• Pakistan's trauma mortality pattern partially aligns with the trimodal distribution, with a notable late mortality peak due to complications.
• There is an urgent need to enhance trauma care systems in Pakistan to mitigate late-stage mortality.
• Further research is necessary to fully elucidate the drivers of mortality among admitted trauma patients in Pakistan.