Academic Journal
Injury mechanism patterns, mortality predictors, and resource utilization in pediatric trauma in Karachi, Pakistan: A seven-year registry study.
| Τίτλος: | Injury mechanism patterns, mortality predictors, and resource utilization in pediatric trauma in Karachi, Pakistan: A seven-year registry study. |
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| Συγγραφείς: | Lahoti GA; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: gal77@rwjms.rutgers.edu., Ismail H; Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan. Electronic address: humera.ismail@smbbit.gos.pk., Kewalramani D; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: dk1362@rwjms.rutgers.edu., Dalal N; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: npd57@rwjms.rutgers.edu., Benton J; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: jb2066@rwjms.rutgers.edu., Choron RL; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: rc1147@rwjms.rutgers.edu., Englert Z; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., DeAnnuntis J; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Whitley D; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Hanna J; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Barie PS; Division of Trauma, Burns, Acute and Critical Care, Department of Surgery, Weill Cornell Medicine, New York, NY, USA. Electronic address: pbarie@med.cornell.edu., Memon S; Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, Pakistan. Electronic address: sabir.memon@smbbit.gos.pk., Narayan M; Division of Acute Care Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA. Electronic address: mayur.narayan@rutgers.edu. |
| Πηγή: | Injury [Injury] 2026 Oct; Vol. 57 (10), pp. 113514. Date of Electronic Publication: 2026 Jul 17. |
| Τύπος έκδοσης: | Journal Article |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Elsevier Country of Publication: Netherlands NLM ID: 0226040 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0267 (Electronic) Linking ISSN: 00201383 NLM ISO Abbreviation: Injury Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2002->: Amsterdam : Elsevier Original Publication: Bristol, Wright. |
| Ιατρικοί όροι (MeSH): | Wounds and Injuries*/mortality , Wounds and Injuries*/epidemiology , Wounds and Injuries*/therapy , Accidents, Traffic*/statistics & numerical data , Accidents, Traffic*/mortality, Pakistan/epidemiology ; Trauma Centers/statistics & numerical data ; Accidental Falls/statistics & numerical data ; Accidental Falls/mortality ; Health Resources/statistics & numerical data ; Humans ; Female ; Male ; Adolescent ; Registries ; Child ; Retrospective Studies ; Injury Severity Score ; Child, Preschool ; Infant ; Hospital Mortality ; Motorcycles |
| Περίληψη: | Background: Pakistan faces a particularly severe pediatric trauma burden due to its large youth population, ubiquitous motorcycle use, and limited traffic safety enforcement. Low- and middle-income countries bear the vast majority of the global injury burden, yet data derived from their trauma registries remain sparse. Methods: We conducted a retrospective analysis of a prospectively maintained pediatric trauma registry in Karachi, Pakistan (2018-2024; n = 4576; outcomes cohort n = 3406). Injury patterns and resource utilization were compared across five age groups. Severity-adjusted mortality was benchmarked using observed-to-expected (O:E) ratios derived from the Revised Trauma Score. Multivariable logistic regression identified independent predictors of in-hospital mortality. Results: Of 4576 patients in the full cohort, motorcycle crashes were the most common mechanism (34%), followed by falls (33%) and pedestrian injuries (12%); falls predominated in children under 10 and motorcycle injuries in adolescents aged 11-18. Males comprised 82% overall and 93% of adolescents aged 15-18. Among 3406 patients with known disposition, crude mortality was 15.1% and varied by age group (χ²=44.1, p < 0.001), ranging from 10.6% in children aged 11-14-34.9% in infants. Resource utilization included blood transfusion (33.4%), operative intervention (20.2%), ICU admission (11.9%), and intubation (6.4%); mortality was 22.5% in high-resource-use patients (ICU admission, intubation, or operative intervention) vs. 11.4% in the remainder (p < 0.001). Among 2480 patients with calculable RTS, the O:E ratio was 1.41 (95% CI 1.27-1.57; 337 observed vs. 238 expected deaths), peaking in 2021 (2.13) and lowest in 2023 (0.77). GCS was the strongest mortality predictor (OR 0.71 per point, 95% CI 0.68-0.73); polytrauma was also associated with higher odds (aOR 2.90, 95% CI 1.13-7.43; 9 deaths among 41 cases). One-third of the full cohort arrived via inter-facility transfer (33.3%, n = 1526). After multivariable adjustment, transfer remained independently associated with higher mortality (aOR 1.88, 95% CI 1.42-2.49). Conclusions: Pediatric trauma mortality in Karachi greatly exceeds RTS-based predictions without anatomic adjustment, especially among the youngest patients. These findings highlight the need for trauma center regionalization, strengthened prehospital systems, and age-specific resuscitation protocols. Systematic O:E monitoring embedded within Pakistan's trauma system represents an immediately deployable quality improvement tool. (Copyright © 2026 British Trauma Society. Published by Elsevier Ltd. All rights reserved.) |
| Competing Interests: | Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. |
| Contributed Indexing: | Keywords: Injury Mechanisms; Inter-facility Transfer; Low-and-middle-income Countries; Mortality Benchmarking; Motorcycle Injuries; Pakistan; Pediatric Trauma; Trauma Registry |
| Entry Date(s): | Date Created: 20260720 Date Completed: 20261007 Latest Revision: 20261007 |
| Update Code: | 20261007 |
| DOI: | 10.1016/j.injury.2026.113514 |
| PMID: | 42475931 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 1879-0267 |
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| DOI: | 10.1016/j.injury.2026.113514 |