{"doi":"10.1002/wjs.12592","title":"Bimodal, But Not the Same: Persistent Late Peaks in Trauma Mortality","abstract":"BACKGROUND: Trauma is a significant cause of morbidity and mortality, disproportionately affecting low- and middle-income countries (LMICs). Data from high-income countries (HIC) show an evolution of Trunkey's trimodal distribution of at-scene, first 48 h and after 7 days mortality to bimodal distribution caused by the flattening of the third peak. The mortality distribution in LMICs is not well described. This paper aims to temporally characterize in-patient trauma-related deaths and identify predictors of this mortality among adults in Pakistan. METHODS: Data from December 2021 to February 2023 were extracted from a multicenter, prospective trauma registry in Karachi, Pakistan. Data on demographics, injury details including injury severity scores (ISS), inhospital care, and outcomes for admitted adult (≥ 18 years) patients not referred from another facility were extracted. The primary outcome was in-patient mortality categorized as within 48 h, after 48 h but within 7 days and after 7 days of injury. Multivariable analyses were done using multiple cox-regression to assess the association of patient and injury characteristics with early (< 48 h) and late mortality (> 48 h). RESULTS: We enrolled 1596 patients. The majority were males (80.70%), aged 18-40 years (55.33%). Half of the patients were admitted with moderate ISS (45.49%). Of these, 293 died (18.36%). Deaths were mainly due to road traffic crashes (66.55%) and head injury (84.98%). An equal proportion of mortality was observed in the < 48 h and day 2-7 groups. One vague mortality peak was also identified at > 7 days (n = 115). The adjusted hazard ratio for early mortality was 15% higher (95% CI 1.13, 1.18) for every one-unit increase in the ISS score. The presence of multiple co-morbidities (AHR = 4.95 95% CI 1.31, 18.68) and head injury (AHR = 15.25 95% CI 3.82, 60.81) were associated with late mortality. CONCLUSIONS: In conclusion, our trauma mortality pattern aligns partially with Trunkey's 1983 trimodal distribution, showing a persistent late mortality attributed to deaths from complications. This highlights an urgent need for improvements in trauma care to reduce late-stage mortality. Further in-depth analysis is required to understand the underlying mortality drivers among admitted patients.","journal":"World Journal of Surgery","year":2025,"id":564533,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9494,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1429814,"name":"Komal Abdul Rahim","orcid":"0000-0002-0790-6644","position":1,"is_corresponding":false},{"id":825535,"name":"Kantesh Kumar","orcid":"0000-0002-2147-4614","position":2,"is_corresponding":false},{"id":1467843,"name":"Sijal Akhter Sheikh","orcid":null,"position":3,"is_corresponding":false},{"id":1094427,"name":"Sheza Hassan","orcid":"0000-0002-9432-8212","position":4,"is_corresponding":false},{"id":1094424,"name":"Asma Altaf Hussain Merchant","orcid":"0000-0002-0393-2079","position":5,"is_corresponding":false},{"id":1094425,"name":"Natasha Shaukat","orcid":"0000-0001-7002-0814","position":6,"is_corresponding":false},{"id":1027852,"name":"Huba Atiq","orcid":"0000-0001-9988-7518","position":7,"is_corresponding":false},{"id":1343398,"name":"Tanweer Ahmed","orcid":null,"position":8,"is_corresponding":false},{"id":476658,"name":"Saima Mushtaq","orcid":"0000-0003-4168-2207","position":9,"is_corresponding":false},{"id":409743,"name":"Adil H. Haider","orcid":"0000-0003-0101-5573","position":10,"is_corresponding":false},{"id":1467844,"name":"Junaid Abdul Razzak","orcid":null,"position":11,"is_corresponding":false},{"id":1467510,"name":"Muhammad Bazil Musharraf","orcid":"0000-0001-7246-5489","position":0,"is_corresponding":true}],"reference_count":46,"raw_metadata":null,"created_at":"2026-07-19T02:56:20.933088Z","pmid":"40261189","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}