Evidence map›Paper›PMID 41691261›Full record

Observational studyWorld journal of emergency surgery : WJES2026

Independent risk of death from hemorrhage and traumatic brain injury in polytrauma: findings from a prospective, multi-center study in the Western Cape of South Africa.

Jessica L Wild, Julia M Dixon, Mengli Xiao, Hendrick J Lategan, George Oosthuizen, Steven G Schauer, Elmin Steyn, Janette Verster, Craig Wylie, Shaheem de Vries and 5 more

Abstract readMulticenter StudyObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in World journal of emergency surgery : WJES, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Jessica L Wild *Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA.
Julia M Dixon *Department of Emergency Medicine, University of Colorado School of Medicine, Academic Office 1, Mail Stop C-326, 12631 E 17Th Ave, Aurora, CO, 80045, USA.
Mengli XiaoDepartment of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, USA.
Hendrick J LateganDivision of Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa.
George OosthuizenDivision of Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa.
Steven G SchauerUnited States Army Institute of Surgical Research, San Antonio, TX, USA.
Elmin SteynDivision of Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa.
Janette VersterDivision of Forensic Pathology, Department of Pathology, Stellenbosch University, Cape Town, South Africa.
Craig WylieWestern Cape Government Emergency Medical Services, Cape Town, South Africa.
Shaheem de VriesCollaborative for Emergency Care in Africa, Cape Town, South Africa.
EpiC Study Site Collaborators
Adriaan VlokDivision of Neurosurgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa.
Willem StassenDivision of Emergency Medicine, Department of Family, Community and Emergency Care, University of Cape Town, Cape Town, South Africa.
Maria KohlbrennerDepartment of Emergency Medicine, University of Colorado School of Medicine, Academic Office 1, Mail Stop C-326, 12631 E 17Th Ave, Aurora, CO, 80045, USA.
Nee-Kofi Mould-MillmanDepartment of Emergency Medicine, University of Colorado School of Medicine, Academic Office 1, Mail Stop C-326, 12631 E 17Th Ave, Aurora, CO, 80045, USA. nee-kofi.mould-millman@cuanschutz.edu.

Funding

Defense Health Agency W81XWH-19-2-0055
6 · The paper itself

Abstract

backgroundInjury is one of the leading causes of death globally, with the largest burden in low- and middle-income countries. Injuries resulting in both hemorrhage and traumatic brain injury (TBI) are associated with high mortality. We seek to quantify the contribution of each injury process, hemorrhage and TBI, and their severity on mortality among patients with concurrent hemorrhage + TBI.

methodsThis is a secondary analysis from the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) study conducted in the Western Cape, South Africa. Adult patients experiencing both hemorrhage + TBI were included. Hemorrhage and TBI severity (mild, moderate, or severe) were assigned according to physiology, injury severity, laboratory and imaging data, and clinical interventions. The independent association of hemorrhage and TBI severity on 7-day mortality was assessed by an adjusted Cox proportional hazards model. Adjustment covariates included age, sex, primary EMS transport, TEWS, and NISS. Secondary endpoints included 48-h and 30-day mortality.

resultsA total of 877 patients were included in the final analysis. Patients were 86% (n = 758) male with a median age of 32 years. 66% (n = 581) of patients were injured by a non-penetrating force. The adjusted rate of death was significantly higher with increasing severity of both hemorrhage and TBI. For the primary outcome of 7-day mortality, severe TBI compared to mild had a 5.11 times higher rate of mortality (aHR 5.11, 95% CI 3.29-7.93) and severe versus moderate TBI had a 5.02 times higher rate (aHR 5.02, 95% CI 4.22-5.96). When assessing across hemorrhage severity, the rate of 7-day mortality was 4.5 times higher (aHR 4.5, 95% CI 3.70-5.47) comparing severe to mild and 3.2 times higher (aHR 3.2, 95% CI 2.53-4.12) comparing severe to moderate. The largest increased rate of death was found in the 48-h mortality analysis comparing severe to mild hemorrhage, with an 18.4 times higher mortality rate (aHR 18.4, 95% CI 12.02-28.21).

conclusionsIncreasing severity of hemorrhage and TBI are both independently associated with a three to five times higher rate of 7-day mortality. These findings highlight the importance of timely hemorrhage control and resuscitation to reduce mortality and the risk of progression to severe disease.

Indexed as

Brain Injuries, TraumaticHemorrhageMultiple TraumaAdultFemaleHumansInjury Severity ScoreMaleMiddle AgedProportional Hazards ModelsProspective StudiesRisk FactorsSouth AfricaGlobal healthHemorrhageInjuryLMICLow-income countryMortalityPolytraumaSouth AfricaTraumaTraumatic brain injury

Identifiers

PMID41691261
PMCPMC13011325

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.