Changing time of death after major trauma in Scotland

Classic trauma mortality models, including Trunkey's trimodal distribution and Wyatt's 1995 Lothian study, reported most major trauma deaths occurring within the first hour after injury. Recent UK data suggest a shift in trauma demographics towards older patients and low-energy mechanisms, which may alter established mortality timelines. This study aimed to provide the first update of trauma fatality time frames in Scotland.

We conducted a retrospective observational study of all patients aged ≥12 years who died from major trauma (Injury Severity Score ≥16) in the Lothian region of Scotland between 1 February 2022 and 31 January 2024. Data were obtained from the Edinburgh University Forensic Pathology database and the Scottish Trauma Audit Group registry. Time from injury to death was categorised as: within 1 hour, 1-4 hours or >4 hours. Mechanism, intent, age and sex were also analysed.

A total of 208 major trauma deaths were identified. Overall, 67 (32.2%) occurred within 1 hour, 15 (7.2%) between 1 and 4 hours and 126 (60.6%) after 4 hours. Same-level falls accounted for 68 deaths (33%). Patients aged >65 years comprised 54% of the cohort; in this subgroup, late deaths were most common.

The distribution of trauma deaths in Lothian has shifted markedly since 1995, with fewer immediate deaths and more late in-hospital fatalities, driven largely by same-level falls in older adults. These findings underline the need for trauma systems to focus on targeted prevention and management strategies for elderly patients at risk of late complications.