Mortality of Trauma Patients in Conflict-Affected Region: A Retrospective Observational Study of ICU Admissions and Surgical Management

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This research investigates the trends, treatment approaches, and outcomes of trauma patients within a mixed intensive care unit (ICU) at HEAL Africa Hospital located in North Kivu, Democratic Republic of Congo (DRC). Methods: A retrospective cohort study was undertaken to evaluate data from 368 surgical patients who were admitted to the ICU of HEAL Africa Hospital from January 2021 to June 2023. The study gathered information regarding patient demographics, mechanisms of injury, diagnoses, management strategies, types of surgeries performed, utilization of mechanical ventilation, duration of hospital stay, and mortality rates. Data analysis was conducted using SPSS version 26, with categorical data expressed as frequencies. Statistical significance was evaluated using the chi-square test. Factors with a p-value of less than 0.25 in the bivariate analysis were then included in a multivariable logistic regression model. Results: Among the 368 surgical patients, 167 (45.3%) were trauma cases, predominantly male (sex ratio 4.4:1) with a median age of 32 years. From these 167 cases, motor vehicle collision (MVC) (63.5%) and gunshot wounds (21.6%) were the leading causes of injury. Traumatic brain injury was the most common diagnosis (39.5%), and only 39.5% of patients underwent surgery. Mechanical ventilation was used in 30% of cases. The median length of stay was 2 days, and the overall mortality rate was 28.7%. Patients with extremity trauma were less likely to die while higher mortality rates were observed among mechanically ventilated patients (p<0.001) and non-operated patients (p=0.006). Conclusion: This research underscores the considerable impact of trauma in areas affected by conflict and stresses the critical necessity for the enhancement of trauma care systems and the implementation of targeted interventions aimed at improving surgical outcomes in resource-limited environments. Trial registration: not applicable Trauma intensive care unit outcomes low-resource setting Figures Figure 1 BACKGROUNG Trauma constitutes a significant global health issue, accounting for approximately 4.4 million fatalities each year, with a majority occurring in low- and middle-income countries (LMICs) where healthcare systems frequently lack the capacity to adequately address critical cases [ 1 , 2 ]. The Democratic Republic of Congo (DRC), especially the eastern province of North Kivu, has been profoundly impacted by prolonged armed conflict, leading to severe consequences for its civilian population and an increase in trauma-related injuries [ 3 ]. The healthcare infrastructure in this region is critically undermined, marked by a drastic shortage of qualified surgeons and the absence of a structured trauma care system. Additionally, challenges such as insufficient pre-hospital care, restricted access to specialized medical services, and a precarious security situation further obstruct the effective management of trauma patients [ 4 – 7 ]. A notable gap exists in the comprehension of the outcomes for trauma patients who are admitted to the ICU within this region. This research seeks to assess the trends, management approaches, and outcomes of trauma patients in the mixed ICU at HEAL Africa Hospital located in North Kivu. By shedding light on these essential elements, we aim to contribute to the wider conversation regarding the improvement of surgical care and trauma management in LMICs, ultimately supporting global surgical initiatives that respond to the pressing needs of vulnerable populations affected by conflict. MATERIAL AND METHODS Study Setting This research was carried out at HEAL (Healthcare, Education, Community Action, and Leadership) Africa Hospital, a Christian non-governmental hospital with 200-bed located in Goma, Eastern DRC [ 8 ]. Within the mixed intensive care units, there are six beds allocated for critically ill patients. The hospital offers a structured four-year Master of Surgery residency program in collaboration with the University of Goma, accommodating four surgical residents at time. This hospital is accredited by the College of Surgeons of East, Central, and Southern Africa to provide training for surgical residents up to the membership level. HEAL Africa Hospital has a single anesthesiologist who heads both the Anesthesiology and Intensive Care Unit (ICU) departments. The ICU staff comprises 12 nurses, four of whom have specialized ICU training, and one holds a Master's degree in Intensive Care Nursing, the remaining nurses have general nursing training. All departments with patients in this mixed ICU conduct rounds on their patients. Three general surgeons and two orthopedic trauma surgeons attend to the surgical patients admitted to the ICU. Study Design This is a retrospective observational study. A review of trauma patient admissions and their outcomes was conducted between January 2021 and June 2023. Data collection Data were gathered from the registry of ICU admissions and discharges for all trauma patients who were admitted between January 2021 and June 2023. In the absence of electronic medical records, a handwritten registry is maintained by the head nurse of the ICU. This investigation encompassed all trauma patients admitted to the ICU; however, not all patients underwent surgical procedures. The primary reasons for this included significant medical comorbidities that posed a high surgical risk, family decisions to forgo surgical treatment, and the lack of available trained neurosurgeons for specific conditions. Despite not undergoing surgery, these patients were included in the study as they represent real-world situations where the risk of mortality persists in the absence of surgical intervention. Their inclusion enhances the understanding of surgical decision-making processes and the associated mortality risks within this patient population. Patients who were admitted to the ICU for non-trauma surgical reasons were excluded from this analysis. Data extraction was performed using a pre-established form designed to identify all trauma patients, gathering information on demographics, injury mechanisms, diagnoses, management approaches, types of surgeries conducted, mechanical ventilation usage, length of stay, and mortality rates. Data Analysis Data were entered into an Excel spreadsheet and subsequently imported into SPSS version 26 for analysis. Categorical variables were summarized using frequencies and cross-tabulated to assess associations. Statistical significance was evaluated using the chi-square test, specifically employing Fisher's exact test when cells had expected counts less than 5, and Pearson's chi-square test when expected counts were 5 or greater. Factors with a p-value of less than 0.25 in the bivariate analysis were then included in a multivariable logistic regression model. A p-value of < 0.05 in the final logistic regression model was considered statistically significant, and a relative risk (RR) greater than 1 indicated an increased risk of mortality. RESULTS Of the 368 surgical patients admitted to HEAL Africa Hospital's mixed ICU during the study period, 167 (45.3%) were trauma cases and included in this analysis. (see Fig. 1 ) The demographic assessment indicated a pronounced male majority, with a sex ratio of 4.4:1. The average age of trauma patients was 32 years, and a significant 73.7% were aged 45 years or younger. The predominant cause of injury was MVC, which represented 63.5% of the cases, followed by gunshot wounds at 21.5%. Traumatic brain injury (TBI) emerged as the most prevalent diagnosis, affecting 39.5% of patients, while extremity trauma and abdominal trauma accounted for 17.4% and 13.8%, respectively. Surgical procedures were infrequently performed, with only 39.5% of trauma patients receiving surgical intervention. The most frequently conducted surgeries were craniotomy and exploratory laparotomy, each making up 12% of the total surgical cases. Mechanical ventilation was administered to 30% of patients admitted to the ICU. The median duration of stay in the ICU was 2 days, with more than half (57.5%) of patients remaining for 48 hours or less. The overall mortality rate among trauma patients in this context was notably high, reaching 28.7% (see Table 1 ). Table 1 Patients’ characteristics Patient characteristics All patients (n = 167) Percentage Sex F 31 18.6 M 136 81.4 Age at admission ≤ 45 years 123 73.7 > 45 years 44 26.3 Mechanism of injury Assault 3 1.8 Burn 4 2.4 Fall 18 10.8 Gunshot 36 21.5 MVC 106 63.5 Diagnosis Abdominal trauma 23 13.8 Chest trauma 10 6 Extremity trauma 29 17.4 Other trauma * 18 10.8 Polytrauma 21 12.5 TBI 66 39.5 Management w/o operation # 101 60.5 With operation 66 39.5 Procedure Chest tube 6 3.6 Craniotomy 20 12 Exploratory laparotomy 20 12 Internal fixation of fracture 9 5.4 Other procedures ** 11 6.6 w/o operation 101 60.5 Mechanical ventilation No 117 70 Yes 50 30 Length of stay > 48 hours 71 42.5 ≤ 48 hours 96 57.5 Death No 119 71.3 Yes 48 28.7 *: Other trauma includes maxillofacial trauma (2 cases), Burn injury (4 cases) and spine trauma (12 cases). **: Other procedure includes debridement (8 cases) and laminectomy (3 cases). # : without operation. The results of our study suggest that the management approach (operative versus non-operative) did not show a significant correlation with the mechanism of injury (p = 0.116), the diagnosis (p = 0.106), or the duration of hospital stay (p = 0.347) (see Table 2 ). Table 2 Patients’ characteristics and surgical provision Patient characteristics All patients, n (%) W/o operation With operation p-value Total 167 (100) 101 66 Mechanism of injury 0.116 + Assault 3 (1.8) 0 3 (4.5) Burn 4 (2.4) 3 (2.9) 1 (1.5) Fall 18 (10.8) 14 (13.9) 4 (6) Gunshot 36 (21.6) 20 (19.8) 16 (24.2) MVC 106 (63.5) 64 (63.4) 42 (63.6) Diagnosis 0.106 + Abdominal trauma 23 (13.8) 9 (8.9) 14 (21.2) Chest trauma 10 (6) 4 (3.7) 6 (9.1) Extremity trauma 29 (17.4) 20 (19.8) 9 (13.6) Other trauma 18 (10.8) 14 (13.8) 4 (6.1) Polytrauma 21 (12.6) 13 (12.9) 8 (12.1) TBI 66 (39.5) 41 (40.6) 25 (37.9) Length of stay 0.347 ++ > 48 hours 71 (42.5) 40 (39.6) 31 (47) ≤ 48 hours 96 (57.5) 61 (60.4) 35 (53) + : fisher’s test, ++ : Pearson’s test In terms of mortality, the analysis revealed no statistically significant differences associated with sex (p = 0.123), age (p = 0.701), mechanisms of injury (p = 0.852), or length of hospital stay (p = 0.389). Conversely, significant differences were identified in relation to the diagnosis (p = 0.002), the type of management administered (p = 0.001), the procedures conducted (p = 0.005), and the application of mechanical ventilation (p < 0.001) (see Table 3 ). Table 3 Patients’ characteristics and the mortality rate Patient characteristics All patient n (%) Survived n (%) Died n (%) p-value Total 167 (100) 119 (71.3) 48 (28.7) Sex 0.123 ++ F 31 (18.5) 26 (21.8) 5 (10.4) M 136 (81.4) 93 (78.2) 43 (89.6) Age 0.701 ++ ≤ 45 years 123 (73.7) 89 (74.8) 34 (70.8) > 45 years 44 (26.3) 30 (25.2) 14 (29.2) Mechanism of injury 0.852 + Assault 3 (1.8) 2 (1.7) 1 (2.1) Burn 4 (2.4) 2 (1.7) 2 (4.2) Fall 18 (10.8) 13 (11) 5 (10.4) Gunshot 36 (21.6) 27 (22.7) 9 (18.7) MVC 106 (63.5) 75 (63) 31 (64.6) Diagnosis 0.002 + Abdominal trauma 23 (13.8) 14 (11.8) 9 (18.7) Chest trauma 10 (6) 9 (7.6) 1 (2.1) Extremity trauma 29 (17.4) 28 (23.5) 1 (2.1) Other trauma 18 (10.8) 14 (11.7) 4 (8.3) Polytrauma 21 (12.6) 13 (11) 8 (16.7) TBI 66 (39.5) 41 (34.4) 25 (52.1) Management 0.001 ++ w/o operation 101 (60.5) 64 (53.8) 37 (77.1) With operation 66 (39.5) 55 (46.2) 11 (22.9) Procedure 0.005 + Chest tube 6(3.6) 6 (5) 0 (0) Craniotomy 20(12) 19 (16) 1 (2.1) Exploratory laparotomy 20(12) 12 (10.1) 8 (16.7) Internal fixation of fracture 9(5.4) 8 (6.7) 1 (2.1) Other procedure 11(6.5) 10 (8.4) 1 (2) w/o operation 101(60.5) 64 (53.8) 37 (77.1) Mechanical ventilation 48 hours 71 (42.5) 53 (44.5) 18 (37.5) ≤ 48 hours 96 (57.5) 66 (55.5) 30 (62.5) + : fisher’s test, ++ : Pearson’s test Further analysis using logistic regression revealed a higher RR (2.404) for males, indicating a higher association with death compared to females, although this trend did not reach statistical significance (p = 0.093). Conversely, patients with extremity trauma showed a significantly reduced risk of mortality, with a RR of 0.056 and a p-value of 0.009. Moreover, the absence of surgical intervention was strongly linked to increased mortality, with a RR of 2.891 and a p-value of 0.006. Exploratory laparotomy, while associated with a high RR of 6.667, did not reach statistical significance (p = 0.097) (see Table 4 ). Table 4 Factors associated with death Variables Number n(%) Death n(%) RR 95% CI p-value Total 167(100) 48(28.7) Sex 0.072 F 31 (18.5) 5 (10.4) 1 - - - M 136 (81.4) 43 (89.6) 2.404 0.864 6.688 0.093 Diagnosis 0.001 Abdominal trauma 23 (28.7) 9 (18.7) 1 - - - Chest trauma 10(6) 1 (2.1) 0.173 0.019 1.606 0.123 Extremity trauma 29(17.4) 1 (2.1) 0.056 0.006 0.483 0.009 Other trauma 18 (10.8) 4 (8.3) 0.444 0.111 1.787 0.253 Polytrauma 21(12.6) 8 (16.7) 0.957 0.284 3.227 0.944 TBI 66(39.5) 25 (52.1) 0.949 0.358 2.512 0.915 Management 0.004 w/o operation 101(60.5) 37 (77.1) 2.891 1.347 6.203 0.006 With operation 66(39.5) 11 (22.9) 1 - - - Mechanical ventilation < 0.001 No 117(70.1) 0 0.000 0.000 - 0.995 Yes 50(29.9) 48 (100) 1 - - - Procedure 0.001 Other procedures 11 (6.5) 1 (2) 1 - - - Chest tube 6(3.6) 0 0.000 0.000 - 0.999 Craniotomy 20(12) 1 (2.1) 0.526 0.030 9.335 0.662 Exploratory laparotomy 20(12) 8 (16.7) 6.667 0.708 62.738 0.097 Internal fixation of fracture 9(5.4) 1 (2.1) 1.250 0.067 23.259 0.881 w/o operation 101(60.5) 37 (77.1) 5.781 0.711 46.98 0.101 DISCUSSION There is a significant lack of data regarding the management and outcomes of trauma patients admitted to the ICU in Eastern DRC. This single-center retrospective review aims to assess the patterns, management strategies, and outcomes of trauma patients in a mixed intensive care unit. It serves as the first report detailing experiences from a referral hospital in Goma, the capital of North Kivu. By addressing this critical gap, the study seeks to enhance understanding of trauma care effectiveness in conflict-affected regions like North Kivu [ 9 ] and contribute to improving surgical practices in low-resource settings. The research indicated that 45.3% of surgical patients in the mixed ICU were classified as trauma cases, exhibiting a significant male predominance with a sex ratio of 4.4:1 and a median age of 32 years. This demographic pattern corresponds with international trends that reveal a higher incidence of trauma among younger males, especially in regions impacted by conflict, where incidents of violence and MVC are common [ 10 , 11 ]. Interestingly, patient age was not associated with mortality, a finding supported by other studies [ 12 – 14 ]. This lack of association may be attributed to the generally younger age of our overall population [ 15 ]. The leading mechanisms of injury were MVC (63.5%) and gunshot (21.6%), consistent with findings from other research identifying these as the two most common causes of injury [ 16 – 18 ]. Some authors noted assaults as the third most common cause or less frequent overall [ 19 , 20 ]. These findings underscore the need for targeted interventions in our region to reduce preventable injuries through improved road safety measures and violence prevention programs. TBI was the most common diagnosis among patients, affecting 39.5% of cases. This finding corroborates results from other studies [ 16 , 20 , 21 ]. Despite the high incidence of trauma, only 39.5% of patients received surgical intervention, highlighting systemic barriers to timely surgical care in low-resource settings [ 22 , 23 ]. Although the ICU registry does not specify why some patients did not undergo surgery, one potential reason is the unavailability of qualified surgeons to perform specific procedures. This lack of specialized surgical capacity may contribute to the absence of surgical intervention, ultimately leading to increased mortality rates among these patients [ 22 , 24 ]. Another potential reason might be that many patients in low-resource settings, like ours, bear the financial burden of healthcare costs themselves, paying out-of-pocket for medical expenses [ 25 ]. The overall mortality rate for trauma patients was alarmingly high at 28.7%, raising significant concerns about global surgical care. Statistical analysis indicated that mortality rates were significantly influenced by factors such as subspecialty involvement, diagnosis, type of management provided, and the need for mechanical ventilation. Furthermore, patients who did not receive surgical intervention exhibited a significantly higher likelihood of death (p = 0.006), reinforcing the vital role of timely surgical care in improving survival outcomes [ 26 ]. Mechanical ventilation was utilized in 29.9% of trauma patients, but only 1.7% of these patients survived. This high mortality rate mirrors findings from other studies examining surgical patients admitted to ICUs [ 14 , 27 , 28 ]. The low survival rate may be attributed to the fact that mechanical ventilation was primarily used for patients experiencing severe respiratory failure. These findings highlight the urgent need to enhance surgical critical care capacity in low-resource settings. There is a compelling call to action for investment in ICU infrastructure and the training of healthcare providers to ensure the effective delivery of early critical care services [ 29 ]. By prioritizing these initiatives, we can significantly improve patient outcomes and advance global surgical care, ultimately fostering health equity in underserved communities [ 22 ]. Another crucial aspect to highlight is the establishment of a trauma registry system. This can significantly enhance the recording of trauma patients and has been shown to be feasible even in low-resource settings [ 30 ]. By creating such a system, it is possible to identify factors predicting mortality, which can lead to targeted interventions and ultimately improve patient outcomes [ 31 ]. Trauma registries serve as a critical tool for collecting and analyzing data, enabling healthcare providers to monitor and evaluate the quality of care, identify areas for improvement, and inform evidence-based interventions [ 32 ]. LIMITATIONS This analysis is constrained by several limitations, many of which are inherent to conducting research within this complex environment. Primarily, the study is retrospective and depends on an existing ICU database that offers limited information. As a result, our examination concentrated mainly on surgical interventions and mortality rates. Essential aspects such as diagnostic processes, the investigations performed (including laboratory tests and imaging), and the reasons why patients requiring surgery did not receive such interventions were not documented in the database. Moreover, there is insufficient information regarding access to other medical treatments or resuscitative efforts that may have occurred before patients arrived at HEAL Africa Hospital. The lack of a comprehensive medical record system further limits the availability of detailed operative data. Additionally, there is a dearth of regional data outside of HEAL Africa that could shed light on the actual prevalence of trauma cases admitted to the ICU, complicating efforts to accurately assess the overall burden of trauma and its effects on the community. These limitations underscore the necessity for enhanced data collection and management systems to improve future research initiatives in this field. Future research should consider a prospective study design to mitigate the limitations encountered in this study. A more comprehensive analysis could be achieved by comparing pre-conflict and post-conflict data, as well as including a non-trauma patient comparison group. Additionally, incorporating the cost of care into the analysis would help determine its potential influence on treatment and outcomes. CONCLUSION This study highlights the critical challenges faced by trauma patients in conflict-affected regions, using the DRC as a case study. Our findings underscore the importance of timely surgical interventions and the need for enhanced critical care resources, particularly in low-resource settings. The high prevalence of traumatic brain injuries and the significant mortality rates among mechanically ventilated and non-operated patients emphasize the urgency for improved healthcare infrastructure and targeted interventions. As trauma care continues to be a pressing global health issue, especially in conflict zones, our research contributes valuable insights for policymakers and healthcare providers working in similar environments. By addressing these challenges, we can work towards reducing mortality rates and improving outcomes for trauma patients worldwide. Abbreviations CI Confidence Interval COVID Coronavirus disease DRC Democratic Republic of the Congo ICU Intensive Care Unit LMICs Low- and Middle-Income Countries MVC Motor vehicle collision RR Relative Ratio SD Standard Deviation SPSS Statistical Package for Social Sciences TBI Traumatic brain injury Declarations Ethics approval and consent to participate We have ensured adherence to the principles outlined in the Declaration of Helsinki [33]. The protocol for this study was reviewed and approved by the Ethics Committee of HEAL Africa Hospital, with the ethical approval number HA/CEM/01/2024. Due to the retrospective nature of the study, the Ethics Committee of HEAL Africa Hospital waived the need of obtaining informed consent. Consent for publication Not applicable Availability of data and materials All data generated or analyzed during this study are included in this published article Competing interests The authors declare that they have no competing interests Funding No funding was received for this research Authors' contributions JFB designed the study, while KMP and JFB handled data collection and statistical analysis. JFB drafted the main manuscript text, and MAE, KKM, and KMJP revised the manuscript. All authors have read and approved the final version of the manuscript. Acknowledgements Not applicable References World Health Organization. Injuries and violence. 2024; Available from: https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence Spencer SA, Adipa FE, Baker T, Crawford AM, Dark P, Dula D et al. A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive Care Med [Internet]. 2023;49(7):772–84. Available from: https://doi.org/10.1007/s00134-023-07136-2 International Comitee of the Red Cross. The forgotten people of north Kivu: focus on the humanitarian crisis in this province of the Democratic Republic of the Congo. 2024;(March). Available from: https://www.icrc.org/sites/default/files/document_new/file_list/icrc_report_the_forgotten_people_of_north_kivu.pdf Kambere O. Intersecting realities: Exploring the nexus between armed conflicts in eastern Democratic Republic of the Congo and Global Health. One Heal [Internet]. 2024;19(July):100849. Available from: https://doi.org/10.1016/j.onehlt.2024.100849 Mushagalusa CR, Mayeri DG, Kasongo B, Cikomola A, Makali SL, Ngaboyeka A et al. Human Resources for Health Profile of health care workers in a context of instability: a cross – sectional study of four rural health zones in eastern DR Congo (lessons learned). Hum Resour Health [Internet]. 2023;1–15. Available from: https://doi.org/10.1186/s12960-023-00816-6 Altare C, Castelgrande V, Tosha M, Malembaka B. From Insecurity to Health Service Delivery: Pathways and System Response Strategies in the Eastern Democratic Republic of the Congo. 2021;915–27. Kalisya L. Estimation of Met Surgical Needs At Hospitals in the North Kivu Province of the Democratic Republic of Congo. Thesis retrieved from https //www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwiCoqjy6aH_AhWNhf0HHQyADNkQFnoECCcQAQ&url= https%3A%2F%2Fescholarship.mcgill.ca%2Fdownloads%2Fsx61dr54b&usg=AOvVaw2V86Vj2VmKAwDoX9PZYgMS . 2019;(August). HEAL Africa, Africa-Rapport HEAL. Annuel. 2023; Available from: https://www.healafricardc.org/nos-rapports (IOM) IO for M. Humanitarian Situation Report July-September. 2024. 2024;(October):1–3. Available from: https://crisisresponse.iom.int/sites/g/files/tmzbdl1481/files/appeal/documents/IOM DRC Humanitarian Situation Report Jul-Sep 2024.pdf. Adenekan A, Faponle A. Trauma admissions to the ICU of a tertiary hospital in a low resource setting. Afr J Anaesth Intensive Care. 2010;9(2):5–9. Ndaku RB, Factors Predicting Outcome in Adult Trauma Patients Admitted to a Tertiary ICU. SAMJ [Internet]. 2019;26(1):1–4. Available from: https://doi.org/10.1007/s11273-020-09706-3%0Ahttp://dx.doi.org/10.1016/j.jweia.2017.09.008%0Ahttps://doi.org/10.1016/j.energy.2020.117919%0A https://doi.org/10.1016/j.coldregions.2020.103116%0Ahttp://dx.doi.org/10.1016/j.jweia.2010.12.004%0Ahttp://dx.doi.o Patel S, Kacheriwala S, Duttaroy D. Audit of postoperative surgical intensive care unit admissions. Indian J Crit Care Med. 2018;22(1):10–5. Zhang Y, Zhang J, Du Z, Ren Y, Nie J, Wu Z, et al. Risk factors for 28-day mortality in a surgical ICU: A retrospective analysis of 347 cases. Risk Manag Healthc Policy. 2021;14:1555–62. Abebe K, Negasa T, Argaw F. Surgical Admissions and Treatment Outcomes at a Tertiary Hospital Intensive Care Unit in Ethiopia: A Two-Year Review. Ethiop J Health Sci. 2020;30(5):725–32. Populationof.net. Population of Democratic Republic of the Congo. 2024 demographics: density, ratios, growth rate, clock, rate of men to women. 2024; Available from: https://www.populationof.net/democratic-republic-of-the-congo/ C PL, G JM, D RM, M.D. M MM et al. J.B. M,. Trauma admissions to the intensive care unit at a reference hospital in Northwestern Tanzania. Scand J Trauma Resusc Emerg Med [Internet]. 2011;19:61. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=export&id=L560026476%5Cnhttp://dy3uq8jh2v.search.serialssolutions.com?sid=EMBASE&issn=17577241&id=doi:&atitle=Trauma+admissions+to+the+intensive+care+unit+at+a+reference+hospital+in+Northweste Lentsck MH, de Oliveira RR, Corona LP, de Mathias TA. F. Risk factors for death of trauma patients admitted to an intensive care unit. Rev Lat Am Enfermagem. 2020;28. Rizwan M, Hashmi M, Zafar H. A Six-month Retrospective Study of Resources Burden by Trauma Victims in the Surgical Intensive Care Unit of a University Hospital in Pakistan. Cureus. 2018;10(8). Embu HY, Nuhu SI, Isamade ES, Kokong DD, Ozoilo KN, Agbo DO. Characteristics and Outcome of Trauma Patients in a Mixed ICU: A Retrospective Review. OALib. 2016;03(07):1–7. Mamo D, Aklog E, Gebremedhin Y. Patterns of admission and outcome of patients admitted to the intensive care unit of Addis Ababa Burn Emergency and Trauma Hospital. Sci Rep [Internet]. 2023;13(1):1–10. Available from: https://doi.org/10.1038/s41598-023-33437-z Ebirim L, Ojum S. Outcome Of Trauma Admissions In An Intensive Care Unit In The Niger Delta Region Of Nigeria. Internet J Emerg Intensive Care Med. 2012;12(2):2–6. Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569–624. Malemo LK, Yap A, Mitume B, Salmon C, Karafuli K, Poenaru D, et al. Essential surgery delivery in the Northern Kivu Province of the Democratic Republic of the Congo. BMC Surg. 2024;24(1):1–8. Ologunde R, Maruthappu M, Shanmugarajah K, Shalhoub J. Surgical care in low and middle-income countries: Burden and barriers. Int J Surg [Internet]. 2014;12(8):858–63. Available from: http://dx.doi.org/10.1016/j.ijsu.2014.07.009 Bolongaita S, Lee Y, Johansson KA, Haaland ØA, Tolla MT, Lee J et al. Financial hardship associated with catastrophic out-of-pocket spending tied to primary care services in low- and lower-middle-income countries: findings from a modeling study. BMC Med [Internet]. 2023;21(1):1–13. Available from: https://doi.org/10.1186/s12916-023-02957-w Silver DS, Lu L, Beiriger J, Reitz KM, Khamzina Y, Neal MD, et al. Association between timing of operative interventions and mortality in emergency general surgery. Trauma Surg Acute Care Open. 2024;9(1):1–9. Zewudie MM, Melesse DY, Filatie TD, Zeleke ME. Variables associated to intensive care unit (ICU)-mortality among patients admitted to surgical intensive care unit in Ethiopia: a retrospective observational study. BMC Anesthesiol. 2023;23(1):1–9. Carlos Junior T, Franca SA, Okamoto VN, Salge JM, Carvalho CRR. Infection as an independent risk factor for mortality in the surgical intensive care unit. Clinics. 2013;68(8):1103–8. Crawford AM, Shiferaw AA, Ntambwe P, Milan AO, Khalid K, Rubio R et al. Global critical care: a call to action. Crit Care [Internet]. 2023;27(1):1–8. Available from: https://doi.org/10.1186/s13054-022-04296-3 Purcell LN, Nip E, Gallaher J, Varela C, Gondwe Y, Charles A. Design and Implementation of a Hospital-based Trauma Surveillance Registry in a Resource-Poor Setting: A Cost Analysis Study. Injury [Internet]. 2020;51(7):1548–53. Available from: https://doi.org/10.1016/j.injury.2020.04.044 Merchant AAH, Haider AH. International variation in injury burden and comparative outcomes: How injury looks like in different parts of the world. Surg (United States). 2024;176(3):972–5. Pino Sánchez FI, Ballesteros Sanz MA, Cordero Lorenzana L, Guerrero López F. Quality of trauma care and trauma registries. Med Intensiva. 2015;39(2):114–23. The World Medical Association. Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. 2008;(June 1964):1–5. Available from: https://www.wma.net/wp-content/uploads/2016/11/DoH-Oct2008.pdf Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Aug, 2025 Read the published version in BMC Surgery → Version 1 posted Editorial decision: Revision requested 01 Jul, 2025 Editor assigned by journal 01 Jul, 2025 Reviews received at journal 05 Jun, 2025 Reviews received at journal 03 Jun, 2025 Reviews received at journal 01 Jun, 2025 Reviews received at journal 27 May, 2025 Reviewers agreed at journal 26 May, 2025 Reviews received at journal 25 May, 2025 Reviewers agreed at journal 24 May, 2025 Reviewers agreed at journal 22 May, 2025 Reviewers agreed at journal 22 May, 2025 Reviewers agreed at journal 21 May, 2025 Reviewers agreed at journal 20 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviews received at journal 19 May, 2025 Reviewers agreed at journal 19 May, 2025 Reviewers invited by journal 19 May, 2025 Submission checks completed at journal 03 Apr, 2025 First submitted to journal 01 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6001951","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":458961888,"identity":"81228232-7838-42af-9ce9-1b6d4419b814","order_by":0,"name":"Jacques Fadhili Bake","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBAC9gYGM4aEAokEBh4GxgdAAR4+Qlp4DoC0GIC1MBuABNiI0sJgwADSwiYBEiGshf3wtgcPDCzy+HsOH6v8mmMnw8bA/PDRDXxaeNLKDYAOK5Y425Z2W3ZbMtBhbMbGOXi02DPkmEkAtSQ2nOcxuy25jRmohYdNGp8WHv43EC3zz/N/K5bcVk+EFgmoLRvO9rAxftx2mBgtz8pAWooNzxwzlmbcdpyHjZmAX3j4k7dJ/qioy5M7k/zw489t1fb87M0PH+PTggKYecAkscpBgPEHKapHwSgYBaNgxAAAWOdBvJwk/DoAAAAASUVORK5CYII=","orcid":"","institution":"HEAL Africa Hospital","correspondingAuthor":true,"prefix":"","firstName":"Jacques","middleName":"Fadhili","lastName":"Bake","suffix":""},{"id":458961889,"identity":"419cceb0-3f85-4836-b86a-28c1f698c7c3","order_by":1,"name":"Phalek Kambere Mukama","email":"","orcid":"","institution":"HEAL Africa Hospital","correspondingAuthor":false,"prefix":"","firstName":"Phalek","middleName":"Kambere","lastName":"Mukama","suffix":""},{"id":458961890,"identity":"6ce11beb-4f24-4c7e-95ac-c904e0f3c93c","order_by":2,"name":"Mumbere Kigayi Jean-Pierre","email":"","orcid":"","institution":"HEAL Africa Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mumbere","middleName":"Kigayi","lastName":"Jean-Pierre","suffix":""},{"id":458961892,"identity":"cdde8110-cec5-4107-aac5-1098865d9652","order_by":3,"name":"Kabuyaya Kakule Medard","email":"","orcid":"","institution":"HEAL Africa Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kabuyaya","middleName":"Kakule","lastName":"Medard","suffix":""},{"id":458961895,"identity":"e50d7129-17ae-4b9e-a8a9-ce8a301d63f3","order_by":4,"name":"Munyantwari Akomu Eugene","email":"","orcid":"","institution":"North Kivu Provincial Hospital","correspondingAuthor":false,"prefix":"","firstName":"Munyantwari","middleName":"Akomu","lastName":"Eugene","suffix":""}],"badges":[],"createdAt":"2025-02-10 20:23:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6001951/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6001951/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12893-025-03090-6","type":"published","date":"2025-08-01T16:05:27+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83202893,"identity":"1b6a21e6-03e8-4005-afc1-7518131d1832","added_by":"auto","created_at":"2025-05-21 06:47:54","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43488,"visible":true,"origin":"","legend":"\u003cp\u003ePatient flow diagram\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6001951/v1/e26c9575054e4375ccbe1ae8.jpeg"},{"id":88268236,"identity":"e860b1ae-16b1-41ad-9161-b156b9069cd3","added_by":"auto","created_at":"2025-08-04 16:50:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":893094,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6001951/v1/f5186fd5-94d5-441f-b60f-3d7b88549bfa.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mortality of Trauma Patients in Conflict-Affected Region: A Retrospective Observational Study of ICU Admissions and Surgical Management","fulltext":[{"header":"BACKGROUNG","content":"\u003cp\u003eTrauma constitutes a significant global health issue, accounting for approximately 4.4\u0026nbsp;million fatalities each year, with a majority occurring in low- and middle-income countries (LMICs) where healthcare systems frequently lack the capacity to adequately address critical cases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe Democratic Republic of Congo (DRC), especially the eastern province of North Kivu, has been profoundly impacted by prolonged armed conflict, leading to severe consequences for its civilian population and an increase in trauma-related injuries [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The healthcare infrastructure in this region is critically undermined, marked by a drastic shortage of qualified surgeons and the absence of a structured trauma care system. Additionally, challenges such as insufficient pre-hospital care, restricted access to specialized medical services, and a precarious security situation further obstruct the effective management of trauma patients [\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA notable gap exists in the comprehension of the outcomes for trauma patients who are admitted to the ICU within this region. This research seeks to assess the trends, management approaches, and outcomes of trauma patients in the mixed ICU at HEAL Africa Hospital located in North Kivu. By shedding light on these essential elements, we aim to contribute to the wider conversation regarding the improvement of surgical care and trauma management in LMICs, ultimately supporting global surgical initiatives that respond to the pressing needs of vulnerable populations affected by conflict.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cp\u003eStudy Setting\u003c/p\u003e \u003cp\u003eThis research was carried out at HEAL (Healthcare, Education, Community Action, and Leadership) Africa Hospital, a Christian non-governmental hospital with 200-bed located in Goma, Eastern DRC [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Within the mixed intensive care units, there are six beds allocated for critically ill patients.\u003c/p\u003e \u003cp\u003eThe hospital offers a structured four-year Master of Surgery residency program in collaboration with the University of Goma, accommodating four surgical residents at time. This hospital is accredited by the College of Surgeons of East, Central, and Southern Africa to provide training for surgical residents up to the membership level.\u003c/p\u003e \u003cp\u003eHEAL Africa Hospital has a single anesthesiologist who heads both the Anesthesiology and Intensive Care Unit (ICU) departments. The ICU staff comprises 12 nurses, four of whom have specialized ICU training, and one holds a Master's degree in Intensive Care Nursing, the remaining nurses have general nursing training. All departments with patients in this mixed ICU conduct rounds on their patients. Three general surgeons and two orthopedic trauma surgeons attend to the surgical patients admitted to the ICU.\u003c/p\u003e \u003cp\u003eStudy Design\u003c/p\u003e \u003cp\u003eThis is a retrospective observational study.\u003c/p\u003e \u003cp\u003eA review of trauma patient admissions and their outcomes was conducted between January 2021 and June 2023.\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eData were gathered from the registry of ICU admissions and discharges for all trauma patients who were admitted between January 2021 and June 2023. In the absence of electronic medical records, a handwritten registry is maintained by the head nurse of the ICU.\u003c/p\u003e \u003cp\u003eThis investigation encompassed all trauma patients admitted to the ICU; however, not all patients underwent surgical procedures. The primary reasons for this included significant medical comorbidities that posed a high surgical risk, family decisions to forgo surgical treatment, and the lack of available trained neurosurgeons for specific conditions. Despite not undergoing surgery, these patients were included in the study as they represent real-world situations where the risk of mortality persists in the absence of surgical intervention. Their inclusion enhances the understanding of surgical decision-making processes and the associated mortality risks within this patient population.\u003c/p\u003e \u003cp\u003ePatients who were admitted to the ICU for non-trauma surgical reasons were excluded from this analysis. Data extraction was performed using a pre-established form designed to identify all trauma patients, gathering information on demographics, injury mechanisms, diagnoses, management approaches, types of surgeries conducted, mechanical ventilation usage, length of stay, and mortality rates.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were entered into an Excel spreadsheet and subsequently imported into SPSS version 26 for analysis. Categorical variables were summarized using frequencies and cross-tabulated to assess associations. Statistical significance was evaluated using the chi-square test, specifically employing Fisher's exact test when cells had expected counts less than 5, and Pearson's chi-square test when expected counts were 5 or greater. Factors with a p-value of less than 0.25 in the bivariate analysis were then included in a multivariable logistic regression model. A p-value of \u0026lt;\u0026thinsp;0.05 in the final logistic regression model was considered statistically significant, and a relative risk (RR) greater than 1 indicated an increased risk of mortality.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOf the 368 surgical patients admitted to HEAL Africa Hospital's mixed ICU during the study period, 167 (45.3%) were trauma cases and included in this analysis. (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe demographic assessment indicated a pronounced male majority, with a sex ratio of 4.4:1. The average age of trauma patients was 32 years, and a significant 73.7% were aged 45 years or younger. The predominant cause of injury was MVC, which represented 63.5% of the cases, followed by gunshot wounds at 21.5%. Traumatic brain injury (TBI) emerged as the most prevalent diagnosis, affecting 39.5% of patients, while extremity trauma and abdominal trauma accounted for 17.4% and 13.8%, respectively. Surgical procedures were infrequently performed, with only 39.5% of trauma patients receiving surgical intervention. The most frequently conducted surgeries were craniotomy and exploratory laparotomy, each making up 12% of the total surgical cases. Mechanical ventilation was administered to 30% of patients admitted to the ICU. The median duration of stay in the ICU was 2 days, with more than half (57.5%) of patients remaining for 48 hours or less. The overall mortality rate among trauma patients in this context was notably high, reaching 28.7% (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients\u0026rsquo; characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePatient characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll patients (n\u0026thinsp;=\u0026thinsp;167)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e81.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;45 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;45 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMechanism of injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAssault\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBurn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGunshot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdominal trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChest trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtremity trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther trauma\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolytrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTBI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eManagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ew/o operation\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChest tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCraniotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExploratory laparotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal fixation of fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther procedures\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ew/o operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMechanical ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLength of stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e42.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*: Other trauma includes maxillofacial trauma (2 cases), Burn injury (4 cases) and spine trauma (12 cases). **: Other procedure includes debridement (8 cases) and laminectomy (3 cases). \u003csup\u003e#\u003c/sup\u003e: without operation.\u003c/p\u003e \u003cp\u003eThe results of our study suggest that the management approach (operative versus non-operative) did not show a significant correlation with the mechanism of injury (p\u0026thinsp;=\u0026thinsp;0.116), the diagnosis (p\u0026thinsp;=\u0026thinsp;0.106), or the duration of hospital stay (p\u0026thinsp;=\u0026thinsp;0.347) (see Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients\u0026rsquo; characteristics and surgical provision\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePatient characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eAll patients,\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eW/o operation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eWith operation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMechanism of injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.116\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssault\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBurn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e3 (2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e14 (13.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGunshot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e20 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16 (24.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106 (63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e64 (63.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e42 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.106\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbdominal trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e9 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e14 (21.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChest trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e4 (3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExtremity trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e20 (19.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e14 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePolytrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e13 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e8 (12.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTBI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e41 (40.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e25 (37.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLength of stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.347\u003csup\u003e++\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e40 (39.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31 (47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 (57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e61 (60.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e35 (53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e\u003csup\u003e+\u003c/sup\u003e: fisher\u0026rsquo;s test, \u003csup\u003e++\u003c/sup\u003e: Pearson\u0026rsquo;s test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn terms of mortality, the analysis revealed no statistically significant differences associated with sex (p\u0026thinsp;=\u0026thinsp;0.123), age (p\u0026thinsp;=\u0026thinsp;0.701), mechanisms of injury (p\u0026thinsp;=\u0026thinsp;0.852), or length of hospital stay (p\u0026thinsp;=\u0026thinsp;0.389). Conversely, significant differences were identified in relation to the diagnosis (p\u0026thinsp;=\u0026thinsp;0.002), the type of management administered (p\u0026thinsp;=\u0026thinsp;0.001), the procedures conducted (p\u0026thinsp;=\u0026thinsp;0.005), and the application of mechanical ventilation (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatients\u0026rsquo; characteristics and the mortality rate\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePatient characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAll patient\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSurvived\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDied\u003c/p\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e119 (71.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.123\u003csup\u003e++\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (21.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136 (81.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (78.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43 (89.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.701\u003csup\u003e++\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;45 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123 (73.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e89 (74.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34 (70.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;45 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (25.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eMechanism of injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.852\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssault\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBurn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFall\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGunshot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36 (21.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27 (22.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMVC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106 (63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75 (63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e31 (64.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.002\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAbdominal trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (13.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChest trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (7.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExtremity trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29 (17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (11.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePolytrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 (12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTBI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e41 (34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e25 (52.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eManagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003csup\u003e++\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ew/o operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101 (60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64 (53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37 (77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWith operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e55 (46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e11 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.005\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eChest tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6 (5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0 (0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCraniotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eExploratory laparotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInternal fixation of fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOther procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (8.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ew/o operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e101(60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e64 (53.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37 (77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e \u003cp\u003eMechanical ventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117 (70.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e117 (98.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e48 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eLength of stay\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.389\u003csup\u003e++\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e71 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e53 (44.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (37.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;48 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96 (57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66 (55.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003csup\u003e+\u003c/sup\u003e: fisher\u0026rsquo;s test, \u003csup\u003e++\u003c/sup\u003e: Pearson\u0026rsquo;s test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFurther analysis using logistic regression revealed a higher RR (2.404) for males, indicating a higher association with death compared to females, although this trend did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.093). Conversely, patients with extremity trauma showed a significantly reduced risk of mortality, with a RR of 0.056 and a p-value of 0.009. Moreover, the absence of surgical intervention was strongly linked to increased mortality, with a RR of 2.891 and a p-value of 0.006. Exploratory laparotomy, while associated with a high RR of 6.667, did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.097) (see Table \u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with death\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDeath n(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eRR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e167(100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48(28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (18.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (10.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e136 (81.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (89.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.404\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.864\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdominal trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (28.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (18.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChest trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.606\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.123\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExtremity trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29(17.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.483\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther trauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (10.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.444\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.787\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePolytrauma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21(12.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.957\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3.227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTBI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (52.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.949\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.512\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.915\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eManagement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ew/o operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101(60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.891\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e1.347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e6.203\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWith operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66(39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMechanical\u003c/p\u003e \u003cp\u003eventilation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e117(70.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.995\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(29.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChest tube\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCraniotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.526\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e9.335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExploratory laparotomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.708\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e62.738\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInternal fixation of fracture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e23.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.881\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ew/o operation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101(60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (77.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e0.711\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e46.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThere is a significant lack of data regarding the management and outcomes of trauma patients admitted to the ICU in Eastern DRC. This single-center retrospective review aims to assess the patterns, management strategies, and outcomes of trauma patients in a mixed intensive care unit. It serves as the first report detailing experiences from a referral hospital in Goma, the capital of North Kivu. By addressing this critical gap, the study seeks to enhance understanding of trauma care effectiveness in conflict-affected regions like North Kivu [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] and contribute to improving surgical practices in low-resource settings.\u003c/p\u003e \u003cp\u003eThe research indicated that 45.3% of surgical patients in the mixed ICU were classified as trauma cases, exhibiting a significant male predominance with a sex ratio of 4.4:1 and a median age of 32 years. This demographic pattern corresponds with international trends that reveal a higher incidence of trauma among younger males, especially in regions impacted by conflict, where incidents of violence and MVC are common [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Interestingly, patient age was not associated with mortality, a finding supported by other studies [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This lack of association may be attributed to the generally younger age of our overall population [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe leading mechanisms of injury were MVC (63.5%) and gunshot (21.6%), consistent with findings from other research identifying these as the two most common causes of injury [\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Some authors noted assaults as the third most common cause or less frequent overall [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These findings underscore the need for targeted interventions in our region to reduce preventable injuries through improved road safety measures and violence prevention programs.\u003c/p\u003e \u003cp\u003eTBI was the most common diagnosis among patients, affecting 39.5% of cases. This finding corroborates results from other studies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the high incidence of trauma, only 39.5% of patients received surgical intervention, highlighting systemic barriers to timely surgical care in low-resource settings [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Although the ICU registry does not specify why some patients did not undergo surgery, one potential reason is the unavailability of qualified surgeons to perform specific procedures. This lack of specialized surgical capacity may contribute to the absence of surgical intervention, ultimately leading to increased mortality rates among these patients [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Another potential reason might be that many patients in low-resource settings, like ours, bear the financial burden of healthcare costs themselves, paying out-of-pocket for medical expenses [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe overall mortality rate for trauma patients was alarmingly high at 28.7%, raising significant concerns about global surgical care. Statistical analysis indicated that mortality rates were significantly influenced by factors such as subspecialty involvement, diagnosis, type of management provided, and the need for mechanical ventilation.\u003c/p\u003e \u003cp\u003eFurthermore, patients who did not receive surgical intervention exhibited a significantly higher likelihood of death (p\u0026thinsp;=\u0026thinsp;0.006), reinforcing the vital role of timely surgical care in improving survival outcomes [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMechanical ventilation was utilized in 29.9% of trauma patients, but only 1.7% of these patients survived. This high mortality rate mirrors findings from other studies examining surgical patients admitted to ICUs [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The low survival rate may be attributed to the fact that mechanical ventilation was primarily used for patients experiencing severe respiratory failure.\u003c/p\u003e \u003cp\u003eThese findings highlight the urgent need to enhance surgical critical care capacity in low-resource settings. There is a compelling call to action for investment in ICU infrastructure and the training of healthcare providers to ensure the effective delivery of early critical care services [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. By prioritizing these initiatives, we can significantly improve patient outcomes and advance global surgical care, ultimately fostering health equity in underserved communities [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Another crucial aspect to highlight is the establishment of a trauma registry system. This can significantly enhance the recording of trauma patients and has been shown to be feasible even in low-resource settings [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. By creating such a system, it is possible to identify factors predicting mortality, which can lead to targeted interventions and ultimately improve patient outcomes [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Trauma registries serve as a critical tool for collecting and analyzing data, enabling healthcare providers to monitor and evaluate the quality of care, identify areas for improvement, and inform evidence-based interventions [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e"},{"header":"LIMITATIONS","content":"\u003cp\u003eThis analysis is constrained by several limitations, many of which are inherent to conducting research within this complex environment. Primarily, the study is retrospective and depends on an existing ICU database that offers limited information. As a result, our examination concentrated mainly on surgical interventions and mortality rates. Essential aspects such as diagnostic processes, the investigations performed (including laboratory tests and imaging), and the reasons why patients requiring surgery did not receive such interventions were not documented in the database.\u003c/p\u003e \u003cp\u003eMoreover, there is insufficient information regarding access to other medical treatments or resuscitative efforts that may have occurred before patients arrived at HEAL Africa Hospital. The lack of a comprehensive medical record system further limits the availability of detailed operative data. Additionally, there is a dearth of regional data outside of HEAL Africa that could shed light on the actual prevalence of trauma cases admitted to the ICU, complicating efforts to accurately assess the overall burden of trauma and its effects on the community. These limitations underscore the necessity for enhanced data collection and management systems to improve future research initiatives in this field. Future research should consider a prospective study design to mitigate the limitations encountered in this study. A more comprehensive analysis could be achieved by comparing pre-conflict and post-conflict data, as well as including a non-trauma patient comparison group. Additionally, incorporating the cost of care into the analysis would help determine its potential influence on treatment and outcomes.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study highlights the critical challenges faced by trauma patients in conflict-affected regions, using the DRC as a case study. Our findings underscore the importance of timely surgical interventions and the need for enhanced critical care resources, particularly in low-resource settings. The high prevalence of traumatic brain injuries and the significant mortality rates among mechanically ventilated and non-operated patients emphasize the urgency for improved healthcare infrastructure and targeted interventions. As trauma care continues to be a pressing global health issue, especially in conflict zones, our research contributes valuable insights for policymakers and healthcare providers working in similar environments. By addressing these challenges, we can work towards reducing mortality rates and improving outcomes for trauma patients worldwide.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConfidence Interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOVID\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCoronavirus disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDRC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDemocratic Republic of the Congo\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive Care Unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow- and Middle-Income Countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMVC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMotor vehicle collision\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRelative Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTBI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTraumatic brain injury\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eWe have ensured adherence to the principles outlined in the Declaration of Helsinki [33]. The protocol for this study was reviewed and approved by the Ethics Committee of HEAL Africa Hospital, with the ethical approval number HA/CEM/01/2024. Due to the retrospective nature of the study, the Ethics Committee of HEAL Africa Hospital waived the need of obtaining informed consent.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study are included in this published article\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo funding was received for this research\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003eJFB designed the study, while KMP and JFB handled data collection and statistical analysis. JFB drafted the main manuscript text, and MAE, KKM, and KMJP revised the manuscript. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. Injuries and violence. 2024; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/injuries-and-violence\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpencer SA, Adipa FE, Baker T, Crawford AM, Dark P, Dula D et al. A health systems approach to critical care delivery in low-resource settings: a narrative review. Intensive Care Med [Internet]. 2023;49(7):772\u0026ndash;84. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00134-023-07136-2\u003c/span\u003e\u003cspan address=\"10.1007/s00134-023-07136-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInternational Comitee of the Red Cross. The forgotten people of north Kivu: focus on the humanitarian crisis in this province of the Democratic Republic of the Congo. 2024;(March). Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.icrc.org/sites/default/files/document_new/file_list/icrc_report_the_forgotten_people_of_north_kivu.pdf\u003c/span\u003e\u003cspan address=\"https://www.icrc.org/sites/default/files/document_new/file_list/icrc_report_the_forgotten_people_of_north_kivu.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKambere O. Intersecting realities: Exploring the nexus between armed conflicts in eastern Democratic Republic of the Congo and Global Health. One Heal [Internet]. 2024;19(July):100849. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.onehlt.2024.100849\u003c/span\u003e\u003cspan address=\"10.1016/j.onehlt.2024.100849\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMushagalusa CR, Mayeri DG, Kasongo B, Cikomola A, Makali SL, Ngaboyeka A et al. Human Resources for Health Profile of health care workers in a context of instability: a cross \u0026ndash; sectional study of four rural health zones in eastern DR Congo (lessons learned). Hum Resour Health [Internet]. 2023;1\u0026ndash;15. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12960-023-00816-6\u003c/span\u003e\u003cspan address=\"10.1186/s12960-023-00816-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAltare C, Castelgrande V, Tosha M, Malembaka B. From Insecurity to Health Service Delivery: Pathways and System Response Strategies in the Eastern Democratic Republic of the Congo. 2021;915\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKalisya L. Estimation of Met Surgical Needs At Hospitals in the North Kivu Province of the Democratic Republic of Congo. Thesis retrieved from https\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e//www.google.com/url?sa=t\u0026amp;rct=j\u0026amp;q=\u0026amp;esrc=s\u0026amp;source=web\u0026amp;cd=\u0026amp;ved=2ahUKEwiCoqjy6aH_AhWNhf0HHQyADNkQFnoECCcQAQ\u0026amp;url= https%3A%2F%2Fescholarship.mcgill.ca%2Fdownloads%2Fsx61dr54b\u0026amp;usg=AOvVaw2V86Vj2VmKAwDoX9PZYgMS\u003c/span\u003e\u003cspan address=\"http:////www.google.com/url?sa=t\u0026amp;rct=j\u0026amp;q=\u0026amp;esrc=s\u0026amp;source=web\u0026amp;cd=\u0026amp;ved=2ahUKEwiCoqjy6aH_AhWNhf0HHQyADNkQFnoECCcQAQ\u0026amp;url= \nhttps%3A%2F%2Fescholarship.mcgill.ca%2Fdownloads%2Fsx61dr54b\u0026amp;usg=AOvVaw2V86Vj2VmKAwDoX9PZYgMS\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 2019;(August).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHEAL Africa, Africa-Rapport HEAL. Annuel. 2023; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.healafricardc.org/nos-rapports\u003c/span\u003e\u003cspan address=\"https://www.healafricardc.org/nos-rapports\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e(IOM) IO for M. Humanitarian Situation Report July-September. 2024. 2024;(October):1\u0026ndash;3. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://crisisresponse.iom.int/sites/g/files/tmzbdl1481/files/appeal/documents/IOM\u003c/span\u003e\u003cspan address=\"https://crisisresponse.iom.int/sites/g/files/tmzbdl1481/files/appeal/documents/IOM\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e DRC Humanitarian Situation Report Jul-Sep 2024.pdf.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAdenekan A, Faponle A. Trauma admissions to the ICU of a tertiary hospital in a low resource setting. Afr J Anaesth Intensive Care. 2010;9(2):5\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNdaku RB, Factors Predicting Outcome in Adult Trauma Patients Admitted to a Tertiary ICU. SAMJ [Internet]. 2019;26(1):1\u0026ndash;4. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s11273-020-09706-3%0Ahttp://dx.doi.org/10.1016/j.jweia.2017.09.008%0Ahttps://doi.org/10.1016/j.energy.2020.117919%0A https://doi.org/10.1016/j.coldregions.2020.103116%0Ahttp://dx.doi.org/10.1016/j.jweia.2010.12.004%0Ahttp://dx.doi.o\u003c/span\u003e\u003cspan address=\"10.1007/s11273-020-09706-3%0A10.1016/j.jweia.2017.09.008%0A10.1016/j.energy.2020.117919%0A10.1016/j.coldregions.2020.103116%0A10.1016/j.jweia.2010.12.004%0A http://dx.doi.o\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel S, Kacheriwala S, Duttaroy D. Audit of postoperative surgical intensive care unit admissions. Indian J Crit Care Med. 2018;22(1):10\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Zhang J, Du Z, Ren Y, Nie J, Wu Z, et al. Risk factors for 28-day mortality in a surgical ICU: A retrospective analysis of 347 cases. Risk Manag Healthc Policy. 2021;14:1555\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbebe K, Negasa T, Argaw F. Surgical Admissions and Treatment Outcomes at a Tertiary Hospital Intensive Care Unit in Ethiopia: A Two-Year Review. Ethiop J Health Sci. 2020;30(5):725\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePopulationof.net. Population of Democratic Republic of the Congo. 2024 demographics: density, ratios, growth rate, clock, rate of men to women. 2024; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.populationof.net/democratic-republic-of-the-congo/\u003c/span\u003e\u003cspan address=\"https://www.populationof.net/democratic-republic-of-the-congo/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eC PL, G JM, D RM, M.D. M MM et al. J.B. M,. Trauma admissions to the intensive care unit at a reference hospital in Northwestern Tanzania. Scand J Trauma Resusc Emerg Med [Internet]. 2011;19:61. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.embase.com/search/results?subaction=viewrecord\u0026amp;from=export\u0026amp;id=L560026476%5Cnhttp://dy3uq8jh2v.search.serialssolutions.com?sid=EMBASE\u0026amp;issn=17577241\u0026amp;id=doi:\u0026amp;atitle=Trauma+admissions+to+the+intensive+care+unit+at+a+reference+hospital+in+Northweste\u003c/span\u003e\u003cspan address=\"http://www.embase.com/search/results?subaction=viewrecord\u0026amp;from=export\u0026amp;id=L560026476%5Cnhttp://dy3uq8jh2v.search.serialssolutions.com?sid=EMBASE\u0026amp;issn=17577241\u0026amp;id=doi:\u0026amp;atitle=Trauma+admissions+to+the+intensive+care+unit+at+a+reference+hospital+in+Northweste\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLentsck MH, de Oliveira RR, Corona LP, de Mathias TA. F. Risk factors for death of trauma patients admitted to an intensive care unit. Rev Lat Am Enfermagem. 2020;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRizwan M, Hashmi M, Zafar H. A Six-month Retrospective Study of Resources Burden by Trauma Victims in the Surgical Intensive Care Unit of a University Hospital in Pakistan. Cureus. 2018;10(8).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmbu HY, Nuhu SI, Isamade ES, Kokong DD, Ozoilo KN, Agbo DO. Characteristics and Outcome of Trauma Patients in a Mixed ICU: A Retrospective Review. OALib. 2016;03(07):1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMamo D, Aklog E, Gebremedhin Y. Patterns of admission and outcome of patients admitted to the intensive care unit of Addis Ababa Burn Emergency and Trauma Hospital. Sci Rep [Internet]. 2023;13(1):1\u0026ndash;10. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41598-023-33437-z\u003c/span\u003e\u003cspan address=\"10.1038/s41598-023-33437-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEbirim L, Ojum S. Outcome Of Trauma Admissions In An Intensive Care Unit In The Niger Delta Region Of Nigeria. Internet J Emerg Intensive Care Med. 2012;12(2):2\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, et al. Global Surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569\u0026ndash;624.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalemo LK, Yap A, Mitume B, Salmon C, Karafuli K, Poenaru D, et al. Essential surgery delivery in the Northern Kivu Province of the Democratic Republic of the Congo. BMC Surg. 2024;24(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlogunde R, Maruthappu M, Shanmugarajah K, Shalhoub J. Surgical care in low and middle-income countries: Burden and barriers. Int J Surg [Internet]. 2014;12(8):858\u0026ndash;63. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1016/j.ijsu.2014.07.009\u003c/span\u003e\u003cspan address=\"10.1016/j.ijsu.2014.07.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBolongaita S, Lee Y, Johansson KA, Haaland \u0026Oslash;A, Tolla MT, Lee J et al. Financial hardship associated with catastrophic out-of-pocket spending tied to primary care services in low- and lower-middle-income countries: findings from a modeling study. BMC Med [Internet]. 2023;21(1):1\u0026ndash;13. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12916-023-02957-w\u003c/span\u003e\u003cspan address=\"10.1186/s12916-023-02957-w\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSilver DS, Lu L, Beiriger J, Reitz KM, Khamzina Y, Neal MD, et al. Association between timing of operative interventions and mortality in emergency general surgery. Trauma Surg Acute Care Open. 2024;9(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZewudie MM, Melesse DY, Filatie TD, Zeleke ME. Variables associated to intensive care unit (ICU)-mortality among patients admitted to surgical intensive care unit in Ethiopia: a retrospective observational study. BMC Anesthesiol. 2023;23(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarlos Junior T, Franca SA, Okamoto VN, Salge JM, Carvalho CRR. Infection as an independent risk factor for mortality in the surgical intensive care unit. Clinics. 2013;68(8):1103\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrawford AM, Shiferaw AA, Ntambwe P, Milan AO, Khalid K, Rubio R et al. Global critical care: a call to action. Crit Care [Internet]. 2023;27(1):1\u0026ndash;8. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13054-022-04296-3\u003c/span\u003e\u003cspan address=\"10.1186/s13054-022-04296-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePurcell LN, Nip E, Gallaher J, Varela C, Gondwe Y, Charles A. Design and Implementation of a Hospital-based Trauma Surveillance Registry in a Resource-Poor Setting: A Cost Analysis Study. Injury [Internet]. 2020;51(7):1548\u0026ndash;53. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.injury.2020.04.044\u003c/span\u003e\u003cspan address=\"10.1016/j.injury.2020.04.044\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMerchant AAH, Haider AH. International variation in injury burden and comparative outcomes: How injury looks like in different parts of the world. Surg (United States). 2024;176(3):972\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePino S\u0026aacute;nchez FI, Ballesteros Sanz MA, Cordero Lorenzana L, Guerrero L\u0026oacute;pez F. Quality of trauma care and trauma registries. Med Intensiva. 2015;39(2):114\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThe World Medical Association. Declaration of Helsinki. Ethical Principles for Medical Research Involving Human Subjects. 2008;(June 1964):1\u0026ndash;5. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.wma.net/wp-content/uploads/2016/11/DoH-Oct2008.pdf\u003c/span\u003e\u003cspan address=\"https://www.wma.net/wp-content/uploads/2016/11/DoH-Oct2008.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Trauma, intensive care unit, outcomes, low-resource setting","lastPublishedDoi":"10.21203/rs.3.rs-6001951/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6001951/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Trauma represents a significant global health challenge, accounting for an estimated 4.4 million fatalities each year, predominantly affecting low- and middle-income countries (LMICs), especially those experiencing conflict. This research investigates the trends, treatment approaches, and outcomes of trauma patients within a mixed intensive care unit (ICU) at HEAL Africa Hospital located in North Kivu, Democratic Republic of Congo (DRC).\u003c/p\u003e\n\u003cp\u003eMethods: A retrospective cohort study was undertaken to evaluate data from 368 surgical patients who were admitted to the ICU of HEAL Africa Hospital from January 2021 to June 2023. The study gathered information regarding patient demographics, mechanisms of injury, diagnoses, management strategies, types of surgeries performed, utilization of mechanical ventilation, duration of hospital stay, and mortality rates. Data analysis was conducted using SPSS version 26, with categorical data expressed as frequencies. Statistical significance was evaluated using the chi-square test. Factors with a p-value of less than 0.25 in the bivariate analysis were then included in a multivariable logistic regression model.\u003c/p\u003e\n\u003cp\u003eResults: Among the 368 surgical patients, 167 (45.3%) were trauma cases, predominantly male (sex ratio 4.4:1) with a median age of 32 years. From these 167 cases, motor vehicle collision (MVC) (63.5%) and gunshot wounds (21.6%) were the leading causes of injury. Traumatic brain injury was the most common diagnosis (39.5%), and only 39.5% of patients underwent surgery. Mechanical ventilation was used in 30% of cases. The median length of stay was 2 days, and the overall mortality rate was 28.7%. Patients with extremity trauma were less likely to die while higher mortality rates were observed among mechanically ventilated patients (p\u0026lt;0.001) and non-operated patients (p=0.006).\u003c/p\u003e\n\u003cp\u003eConclusion: This research underscores the considerable impact of trauma in areas affected by conflict and stresses the critical necessity for the enhancement of trauma care systems and the implementation of targeted interventions aimed at improving surgical outcomes in resource-limited environments.\u003c/p\u003e\n\u003cp\u003eTrial registration: not applicable\u003c/p\u003e","manuscriptTitle":"Mortality of Trauma Patients in Conflict-Affected Region: A Retrospective Observational Study of ICU Admissions and Surgical Management","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-21 06:47:48","doi":"10.21203/rs.3.rs-6001951/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-01T14:13:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-01T14:13:21+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-05T18:07:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-03T17:43:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-01T15:15:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-28T00:27:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"221705691277879157405162020271540405916","date":"2025-05-26T17:30:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-25T18:10:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294218255356311983599437775850881541608","date":"2025-05-24T13:56:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87485734546988016420650574887668516492","date":"2025-05-22T14:26:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83363775325725297370953517709508764089","date":"2025-05-22T13:04:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68215071398592852472251342474500661541","date":"2025-05-21T18:28:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"60152213025876251896408351457291831126","date":"2025-05-20T05:22:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"154971927294158341348907984992268248623","date":"2025-05-19T21:26:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-19T15:44:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"256860085064077338063154337227910307624","date":"2025-05-19T15:32:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-19T13:34:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-04T03:37:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Surgery","date":"2025-04-01T23:45:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bsur","sideBox":"Learn more about [BMC Surgery](http://bmcsurg.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bsur/default.aspx","title":"BMC Surgery","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"416e8f8a-cb6d-4958-9b0d-f687926f7bb4","owner":[],"postedDate":"May 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-08-04T16:42:07+00:00","versionOfRecord":{"articleIdentity":"rs-6001951","link":"https://doi.org/10.1186/s12893-025-03090-6","journal":{"identity":"bmc-surgery","isVorOnly":false,"title":"BMC Surgery"},"publishedOn":"2025-08-01 16:05:27","publishedOnDateReadable":"August 1st, 2025"},"versionCreatedAt":"2025-05-21 06:47:48","video":"","vorDoi":"10.1186/s12893-025-03090-6","vorDoiUrl":"https://doi.org/10.1186/s12893-025-03090-6","workflowStages":[]},"version":"v1","identity":"rs-6001951","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6001951","identity":"rs-6001951","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}