ArticleWorld journal of surgery2025
Bimodal, But Not the Same: Persistent Late Peaks in Trauma Mortality.
Article in World journal of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Improving trauma care in Pakistan: a need for intervention-based studies.Trauma surgery & acute care open · 2026Article
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12 authors.
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Abstract
backgroundTrauma is a significant cause of morbidity and mortality, disproportionately affecting low- and middle-income countries (LMICs). Data from high-income countries (HIC) show an evolution of Trunkey's trimodal distribution of at-scene, first 48 h and after 7 days mortality to bimodal distribution caused by the flattening of the third peak. The mortality distribution in LMICs is not well described. This paper aims to temporally characterize in-patient trauma-related deaths and identify predictors of this mortality among adults in Pakistan.
methodsData from December 2021 to February 2023 were extracted from a multicenter, prospective trauma registry in Karachi, Pakistan. Data on demographics, injury details including injury severity scores (ISS), inhospital care, and outcomes for admitted adult (≥ 18 years) patients not referred from another facility were extracted. The primary outcome was in-patient mortality categorized as within 48 h, after 48 h but within 7 days and after 7 days of injury. Multivariable analyses were done using multiple cox-regression to assess the association of patient and injury characteristics with early (< 48 h) and late mortality (> 48 h).
resultsWe enrolled 1596 patients. The majority were males (80.70%), aged 18-40 years (55.33%). Half of the patients were admitted with moderate ISS (45.49%). Of these, 293 died (18.36%). Deaths were mainly due to road traffic crashes (66.55%) and head injury (84.98%). An equal proportion of mortality was observed in the < 48 h and day 2-7 groups. One vague mortality peak was also identified at > 7 days (n = 115). The adjusted hazard ratio for early mortality was 15% higher (95% CI 1.13, 1.18) for every one-unit increase in the ISS score. The presence of multiple co-morbidities (AHR = 4.95 95% CI 1.31, 18.68) and head injury (AHR = 15.25 95% CI 3.82, 60.81) were associated with late mortality.
conclusionsIn conclusion, our trauma mortality pattern aligns partially with Trunkey's 1983 trimodal distribution, showing a persistent late mortality attributed to deaths from complications. This highlights an urgent need for improvements in trauma care to reduce late-stage mortality. Further in-depth analysis is required to understand the underlying mortality drivers among admitted patients.
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