Public versus private trauma intensive care unit outcomes: A retrospective cohort study

Trauma remains a leading cause of morbidity and mortality in low- and middle-income countries (LMICs), with South Africa experiencing a high burden of intentional and high-energy injuries. Disparities in critical care resources between the public and private healthcare sectors have been reported, but comparative trauma intensive care unit (ICU) outcomes remain incompletely described.

This retrospective cohort study compared adult trauma patients admitted to public and private healthcare sector ICUs in Johannesburg between July 2022 and June 2023. The primary outcome was 30-day in-hospital mortality. Secondary outcomes included injury characteristics, severity of illness and factors associated with mortality. Descriptive statistics and multivariate logistic regression were used for data analysis.

A total of 453 trauma patients were included (private ICU n = 209; public ICU n = 244), with male predominance in both cohorts. Private ICU patients were older, more frequently sustained blunt trauma, and had longer ICU stays. Public ICU patients were younger and more likely to sustain penetrating trauma (68.4% vs 14.4%; p < 0.001). Thirty-day mortality did not differ significantly (private 8.6% vs public 11.9%; p = 0.255), despite greater illness and injury severity among private ICU patients. Greater severity of illness and injury independently predicted mortality, while public ICU admission was associated with increased adjusted odds of mortality.

Despite differences in injury profiles, patient mortality was similar in both healthcare sectors. Illness severity remains the prevailing determinant of outcome, underscoring the importance of severity scoring systems and potential system-level factors in LMICs' trauma care. Level of evidence: Level III; prognostic and epidemiological study.

This study provides comparative trauma ICU outcomes data from the public and private healthcare sectors in Johannesburg, highlighting the role of illness severity and healthcare sector infrastructure on patient mortality and informing trauma critical care in LMICs.