Trauma-related mortality in a European region with an intermediately mature trauma system: a comprehensive population-based analysis

Abstract

Background: Understanding the epidemiology of trauma-related mortality is essential to guide quality improvement and optimize trauma system performance. However, the absence of comprehensive regional registries often limits accurate assessment. This study aimed to characterize trauma-related deaths in Biscay (Spain), a European region with an intermediately mature trauma care system, including both prehospital and in-hospital deaths. Methods: A retrospective, population-based observational study included all trauma-related deaths in 2019 and 2022. Data were obtained from forensic autopsy reports and cross-referenced with clinical registries from the Basque Health Service. Variables analyzed were demographics, injury mechanisms, severity scores (AIS, ISS, NISS), ASA-PS classification, medico-legal intent, and physiopathological cause of death. Years of potential life lost before age 70 (YPLL70) were calculated. Results: A total of 313 trauma-related deaths were recorded: 151 in 2019 and 162 in 2022. Median age was 72 years (P25–P75: 52–84), and 67% were men. Low-energy falls accounted for 41% of cases and high-energy falls for 30%. The medico-legal intent was mainly unintentional (69%), followed by suicide (29%). Traumatic brain injury (47%) and massive hemorrhage (29%) were the leading physiopathological causes. Two distinct profiles emerged: young adults sustaining high-energy trauma with severe injuries, and older adults dying after low-energy mechanisms. Conclusion: This study highlights a dual epidemiological pattern of trauma-related mortality in a region with an intermediately mature trauma system. Adapting trauma care pathways to address both high- and low-energy trauma, particularly in an aging population, may improve efficiency, equity, and clinical outcomes.