Time-based trauma-related mortality patterns in a newly created trauma system

Abstract

BACKGROUND: Data on time-based trauma mortality (TTM) patterns in developing countries are lacking. OBJECTIVE: Our objective was to analyze the TTM in a newly established trauma center. METHODS: A retrospective analysis of all trauma-related mortality between 2010 and 2012 was conducted in Qatar. Based on the time of injury, deceased cases were categorized into immediate (pre-hospital), early (first 24 h), and late (>24 h) groups. TTM was analyzed and compared. RESULTS: A total of 4,966 trauma patients were admitted to the trauma center over 3 years; of them, 333 trauma-related deaths (6.8 %) were documented and reviewed. The death pattern peaked immediately post-trauma (n = 142), followed by 96 deaths within the first 24 h, 19 deaths within the time period >24 to 48 h, 50 deaths within the 3rd and 7th day (second peak), and 26 deaths after the 1st week. The majority of the deceased were males, with a mean age of 36 ± 17 years. Motor vehicle crashes (43.5 %) were the commonest mechanism of injury. At presentation, median injury severity score (ISS) was 32 (range 9-75). Bleeding, abdominal, and pelvic injuries were higher in the early group, whereas head injuries were observed more in the late mortality group. Co-morbidities and in-hospital complications were predominantly encountered in the late group. Head injury (odds ratio [OR] 3.760; 95 % confidence interval [CI] 1.311-10.797) was an independent predictor for late death, whereas the need for blood transfusion was a predictor for early death (OR 3.233; 95 % CI 1.125-9.345). CONCLUSION: The distribution of mortality shows a bimodal pattern. The high rate of death at the scene highlights the importance of pre-hospital care and the need for injury prevention programs.