Work

Characteristics and outcomes of haemorrhage, traumatic brain injury and combined injuries from a South African Trauma Cohort Study

Year: 2026

Type: article

Abstract: Objectives To describe and compare injury severity, clinical management and mortality among haemorrhage, traumatic brain injury (TBI) and combined haemorrhage+TBI cohorts in a South African trauma population. Design Secondary analysis of data from the Epidemiology and Outcomes of Prolonged Trauma Care (EpiC) multicentre observational cohort study, April 2021 to December 2024. Setting Six government health facilities and affiliated government ambulances across the Western Cape, South Africa. Participants 18 840 adult patients with blunt and/or penetrating traumatic injuries enrolled in the EpiC registry were eligible for this secondary analysis. Patients <18 years of age and prisoners are excluded from EpiC. Burn injuries, non-haemorrhage and non-TBI injuries were excluded from this analysis. Patients were assigned to one of three mutually exclusive cohorts (haemorrhage, TBI or haemorrhage+TBI) using anatomic and physiologic criteria. Primary and secondary outcome measures The primary outcome was crude, all-cause prehospital or in-hospital mortality. Mantel-Haenszel risk ratios (RRs) for mortality were adjusted for injury severity, injury force type and mode of prehospital transportation. Secondary outcomes included critical interventions, hospital admission, length of stay and time from injury to death. Results A total of 7614 patients met inclusion: 5146 (67.6%) haemorrhage, 1556 (20.4%) TBI and 912 (12.0%) haemorrhage+TBI. The majority were male (85.1%) with a median age of 31 years. Patients with haemorrhage+TBI received more intensive care, including airway interventions (38%), transfusions (41%) and intensive care unit admissions (36%). Crude mortality was highest in haemorrhage+TBI (31.3%), followed by TBI (7.7%) and haemorrhage (5.4%). After injury-pattern specific severity adjustment, mortality risk remained significantly higher in haemorrhage+TBI than in TBI (RR 1.87, 95% CI 1.60 to 2.19) and haemorrhage (RR 3.38, 95% CI 2.96 to 3.85). Estimates were similar after additional adjustment for injury force and prehospital transportation (RR 1.84 and 2.98). Conclusions In this South African population, haemorrhage+TBI was the least prevalent but most high-risk cohort with greater morbidity and mortality compared with haemorrhage or TBI alone, even after adjusting for injury severity. These findings may inform system level planning and resource allocation particularly in resource-limited settings.

Source: BMJ Open

DOI: 10.1136/bmjopen-2026-120519