Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia

Messelu et al. European Journal of Medical Research (2023) 28:113 https://doi.org/10.1186/s40001-023-01056-z European Journal of Medical Research Open Access RESEARCH Incidence and predictors of mortality among adult trauma patients admitted to the intensive care units of comprehensive specialized hospitals in Northwest Ethiopia Mengistu Abebe Messelu1*, Ambaye Dejen Tilahun2, Zerko Wako Beko3, Hussien Endris4, Asnake Gashaw Belayneh5 and Getayeneh Antehunegn Tesema6 Abstract Background Trauma is the leading cause of morbidity and mortality among adult population in the world. Despite many improvements in technology and care, mortality among trauma patients in the intensive care unit is still high particularly in Ethiopia. However, there is limited evidence on the incidence and predictors of mortality among trauma patients in Ethiopia. Therefore, this study aimed to assess the incidence and predictors of mortality among adult trauma patients admitted to intensive care units. Methods Institutional-based retrospective follow-up study was conducted from January 9, 2019 to January 8, 2022. A total of 421 samples were chosen using simple random sampling. Data were collected with Kobo toolbox software and exported to STATA version 14.1 software for data analysis. Kaplan–Meier failure curve and log-rank test were fitted to explore the survival difference among groups. After the bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with 95% Confidence Intervals (CI) was reported to declare the strength of association and statistical significance, respectively. Result The overall incidence rate of mortality was 5.47 per 100 person-day observation with a median survival time of 14 days. Did not get pre-hospital care (AHR = 2.00, 95%CI 1.13, 3.53), Glasgow Coma Scale (GCS) score < 9 (AHR = 3.89, 95%CI 1.67, 9.06), presence of complications (AHR = 3.71, 95%CI 1.29, 10.64), hypothermia at admission (AHR = 2.11, 95%CI 1.13, 3.93) and hypotension at admission (AHR = 1.93, 95%CI 1.01, 3.66) were found significant predictors of mortality among trauma patients. Conclusion The incidence rate of mortality among trauma patients in the ICU was high. Did not get pre-hospital care, GCS < 9, presence of complications, hypothermia, and hypotension at admission were significant predictors of mortality. Therefore, healthcare providers should give special attention to trauma patients with low GCS scores, complications, hypotension, and hypothermia and better to strengthen pre-hospital services to reduce the incidence of mortality. Keywords Incidence, Intensive care unit, Mortality, Trauma patients, Cox regression *Correspondence: Mengistu Abebe Messelu Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Messelu et al. European Journal of Medical Research (2023) 28:113 Background Trauma has become an international concern due to millions of deaths and disabilities, and it is predicted to be the seventh leading cause of mortality by 2030 in the world [1]. According to World Health Organization (WHO) report, 4.4 million people die every year from unintentional injuries and violence in the world, and it accounts for nearly 8% of overall global mortality [2]. Mortality of trauma specifically due to Road Traffic Accident (RTA) is a growing national concern in Ethiopia [3] and ranks in third place among African nations following South Africa and Nigeria [4]. According to Health Demographic Surveillance (HDS) and Addis Ababa trauma reports about 6.4% and 7% of all deaths are related to trauma, respectively [5, 6], and it is ranked the fourth and fifth leading cause of admission and death, respectively [7]. According to the reviewed literatures, trauma patients accounted for 46.9% of the total Intensive Care Unit (ICU) admitted patients [8], and the mortality of these trauma patients ranged from 3.7 to 28.2% in developed countries [9–13], 23–58% in Africa [14–16] and 12.4–52.8% in Ethiopia [17–19]. Trauma remains the leading cause of death in persons below 45 years of age and it has a negative economic impact due to the loss of socio-economically active people [20]. For each death, there are lots of Emergency Department (ED) visits, ward admissions, ICU admissions, and lifelong disabilities [21]. Currently, it becomes a major challenge in Ethiopia due to increasing accidents, violence, development of technology with poor safety systems, the high population density, and changes in way of living [22]. Trauma patients admitted to the ICU usually presented with injuries in different anatomical areas; head trauma is the most common followed by chest, abdominal, extremity, and pelvic injuries [10, 11, 23, 24]. According to the previous studies conducted across the globe, Glasgow Coma Scale (GCS) score at admission, the severity of the injury, older age, presence of comorbidities, Multi-Organ Failure (MOF), Acute Lung Injury (ALI), sepsis, longer ICU stay, mechanism of injury and traumatic brain injury were independent predictors of mortality among trauma patients admitted in the ICU [10, 13, 14, 25, 26]. Trauma management requires a multidisciplinary approach that begins with pre-hospital care at the trauma site. In the hospital setting, the patients should be stabilized at ED and then admitted to the ICU, which is a multidisciplinary unit struggling with most life-threatening health conditions, where airway support, mechanical ventilation, drug administration and monitoring techniques are provided for patients’ survival [27]. Page 2 of 12 Deaths among trauma patients occur in one of the three phases: immediate death (occurring due to overwhelming injury), early death (occurring within hours after trauma, and delayed death (occurring days to weeks after trauma as a result of treatable infections, MOF or other late complications [1], and during each phase several factors remain associat (...truncated)