Incidence and predictors of early mortality among trauma patients visiting emergency departments of referral hospitals in west Amhara region, Ethiopia.

Although the establishment and growth of trauma systems indicate a move toward a bimodal distribution with a decrease in late deaths, research reveal that deaths within minutes or a few hours after injury remain mostly unaltered. The majority of possibly preventable deaths from trauma occur shortly after injury, with the majority of deaths occurring before hospital admission. This is especially visible in armed conflict or war zones. The purpose of this study was to investigate the incidence and determinants of early mortality among trauma patients who visited emergency departments of referral hospitals in west Amhara, Ethiopia, in 2024. This study conducted an institution-based prospective observational study of 531 trauma patients utilizing a consecutive sampling strategy with an interviewer-administered questionnaire and a structured checklist online using Kobo Collect. The data were exported to Stata 17 for analysis. Descriptive statistics including frequencies, proportions, and medians were computed. The median time was estimated using the Kaplan-Meier curve, and survival differences were compared using the Log-rank test across different categories of explanatory variables. Cox proportional hazards models were employed to investigate the statistical association. The proportional hazard assumptions were statistically and graphically verified using the global test and log-log plots, respectively. The degree of relationship was reported using the hazard ratio and 95% confidence intervals (CIs). The variables with a p-value < 0.25 in the bivariable analysis were included in the multivariable analysis model. Statistical significance was determined using a p-value of less than 0.05. Completed study data were available for 518 trauma patients, representing 97.6% of the intended cohort. The average age of study participants was 33.48 ± 14.05, with males accounting for almost 75% of severe injury victims. During this time, 66 (12.74%) people died. The restricted mean survival time (RMST) was found to be 21 h (95% CI: 20.2-21.7). The overall incidence rate of early mortality was 15.260 per 1000 person-hours (95% CI = 12.00, 19.42) with a total of 4,325 patient-hour observations. Female sex (AHR = 4.27; 95% CI = 2.03, 9.01), ambulance mode of arrival (AHR = 3.52; 95% CI = 1.90, 6.64). DBP of below 60mmHg (AHR = ;10.50; 95% CI = 5.35, 20.59), DBP above 90mmHg (AHR = 7.38; 95% CI = 1.83, 29.80), GCS score indicating moderate (9-12 ) injury (AHR = 8.17; 95%CI = 3.10, 21.63), and GCS score indicating severe (< 9) injury (AHR = 21.20; 95%CI = 9.65, 46.58) were found to be significantly associated with early mortality. This study found that the incidence of early mortality is notable. It identifies important variables associated with early mortality in the study area, such as female sex, abnormal DBP, and GCS score indicating moderate to severe injury. To reduce early trauma mortality, efforts should focus on early detection and management of physiological instability, prompt neurological assessment, and better coordination between referring and referral hospitals.