Time‐Based Trauma‐Related Mortality Patterns in a Newly Created Trauma System

Abdelrahman, Husham; Ayman El‐Menyar; Hassan Al‐Thani; Consunji, Rafael; Zarour, Ahmad; Peralta, Ruben; Parchani, Ashok; Latifi, Rifat · 2014 · Crossref

DOI: 10.1007/s00268-014-2705-x

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Summary

This study investigates time-based trauma mortality (TTM) patterns in Qatar, a developing nation with limited existing data on trauma outcomes. The research was motivated by the establishment of the Hamad Trauma Center (HTC), Qatar’s only Level I trauma center, in 2007. The authors aimed to describe the temporal distribution of trauma-related deaths and identify risk factors associated with early versus late mortality in this newly created trauma system. The researchers conducted a retrospective analysis of all trauma-related deaths recorded at the HTC between January 2010 and December 2012. The study population included 333 deceased patients out of 4,966 total trauma admissions. Deaths were categorized into three groups based on the time of injury: immediate (pre-hospital), early (within 24 hours of admission), and late (after 24 hours). Data collected included demographics, mechanism of injury, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS), blood transfusion requirements, and complications. Statistical analyses, including multivariate logistic regression, were performed to identify independent predictors for early and late mortality. The results revealed a bimodal mortality pattern rather than the classic trimodal distribution. The largest peak occurred immediately post-trauma, with 142 deaths (42.7%) occurring before hospital arrival. The second peak occurred between the third and seventh day of hospitalization, with 50 deaths. Early deaths (within 24 hours) totaled 96 cases, while 26 deaths occurred after the first week. Motor vehicle crashes were the most common mechanism of injury (43.5%), and the majority of victims were males with a mean age of 36 years. Multivariate analysis identified the need for blood transfusion as an independent predictor for early death (OR 3.233), while head injury (OR 3.760) and older age were independent predictors for late death. Early mortality was significantly associated with abdominal and pelvic injuries, whereas late mortality was associated with head injuries, comorbidities such as diabetes and hypertension, and in-hospital complications like ventilator-associated pneumonia. The study concludes that trauma mortality in Qatar follows a bimodal distribution, with a high proportion of deaths occurring pre-hospital. This finding underscores the critical need for improved pre-hospital care and injury prevention programs. The identification of specific predictors for early and late mortality provides actionable insights for trauma management strategies, highlighting the importance of rapid hemorrhage control for early survivors and focused care for traumatic brain injury and complication management for late survivors.

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Topics

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• fatality injury trends
• post crash care delays

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• Empirical Findings: crash risk outcomes