Factors associated with mortality among patients with penetrating non-compressible torso hemorrhage in South Africa: A retrospective cohort study
Introduction: Non-compressible torso haemorrhage (NCTH), resulting from penetrating trauma to the chest, abdomen, or pelvis, places patients at high risk of death. The objectives of this study are to characterize the injury profile of patients with penetrating NCTH who receive care within a tiered p...
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Elsevier
2025-06-01
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| Series: | African Journal of Emergency Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2211419X25000059 |
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| author | Smitha Bhaumik Adane F. Wogu Lani Finck Maria Jamison Mengli Xiao Julia Finn Hendrick Lategan Janette Verster Shaheem de Vries Craig Wylie Lesley Hodson Mohammet Mayet Leigh Wagner L'Oreal Snyders Karlien Doubell Elaine Erasmus George Oosthuizen Christiaan Rees Steven G Schauer Julia Dixon Nee-Kofi Mould-Millman |
| author_facet | Smitha Bhaumik Adane F. Wogu Lani Finck Maria Jamison Mengli Xiao Julia Finn Hendrick Lategan Janette Verster Shaheem de Vries Craig Wylie Lesley Hodson Mohammet Mayet Leigh Wagner L'Oreal Snyders Karlien Doubell Elaine Erasmus George Oosthuizen Christiaan Rees Steven G Schauer Julia Dixon Nee-Kofi Mould-Millman |
| author_sort | Smitha Bhaumik |
| collection | DOAJ |
| description | Introduction: Non-compressible torso haemorrhage (NCTH), resulting from penetrating trauma to the chest, abdomen, or pelvis, places patients at high risk of death. The objectives of this study are to characterize the injury profile of patients with penetrating NCTH who receive care within a tiered public trauma system in South Africa and to identify factors associated with mortality. Methods: This is a secondary analysis of clinical data collected from Sept-2021 through Dec-2023 across 6 hospitals, 4 ambulance bases, and 2 mortuaries in the Western Cape Province that form a cohesive trauma referral pathway. The study included patients age ≥18 years with penetrating NCTH who arrived at the hospital within 3 h and received blood products within 6 h of injury. NCTH was defined as Abbreviated Injury Scale (AIS) ≥ 2 to chest, abdomen or pelvis, with a systolic blood pressure ≤ 100 mm Hg. Data were analysed using multivariable logistic regression and Cox proportional hazards modelling. Results: There were 202 patients with penetrating NCTH; median age was 29 years, 94 % male, injured by stab wounds (66 %) and gunshot wounds (31 %). Most patients (85 %) sustained injuries to the chest, 33 % to the abdomen, and 1.5 % to the bony pelvis. In a multivariable logistic regression model, elevated Triage Early Warning Score (TEWS ≥7) (OR 4.45, 95 % CI 1.58–13.90), elevated New Injury Severity Score (NISS >25) (OR 4.35, 95 % CI 1.45–16.30), anatomic injury to the abdomen/pelvis (OR 2.76, 95 % CI 1.03–7.74), and receipt of acute airway intervention (OR 4.97, 95 % CI 1.94–13.20) were significantly associated with 7-day in-hospital mortality. Conclusion: Among patients with penetrating injuries to the torso, high triage scores, high injury severity, early airway interventions, and penetrating abdominal trauma were associated with elevated mortality risk. |
| format | Article |
| id | doaj-art-847f8599fb4e478e8e96d109d2ca425e |
| institution | DOAJ |
| issn | 2211-419X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Elsevier |
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| series | African Journal of Emergency Medicine |
| spelling | doaj-art-847f8599fb4e478e8e96d109d2ca425e2025-08-20T03:13:03ZengElsevierAfrican Journal of Emergency Medicine2211-419X2025-06-0115261362010.1016/j.afjem.2025.02.002Factors associated with mortality among patients with penetrating non-compressible torso hemorrhage in South Africa: A retrospective cohort studySmitha Bhaumik0Adane F. Wogu1Lani Finck2Maria Jamison3Mengli Xiao4Julia Finn5Hendrick Lategan6Janette Verster7Shaheem de Vries8Craig Wylie9Lesley Hodson10Mohammet Mayet11Leigh Wagner12L'Oreal Snyders13Karlien Doubell14Elaine Erasmus15George Oosthuizen16Christiaan Rees17Steven G Schauer18Julia Dixon19Nee-Kofi Mould-Millman20University of Colorado, Department of Emergency Medicine, Academic Office 1, Mail Stop C-326, 12631 E. 17th Ave, Aurora, CO, 80045, USA; Corresponding author at: Academic Office 1, Mail Stop C-326, 12631 E. 17th Ave, Aurora, CO, USA 80045.Colorado School of Public Health, Department of Biostatistics and Informatics, Fitzsimons Building, 4th Floor, Mail Stop B119 13001 E. 17th Place, Aurora, CO, 80045, USAUniversity of Colorado, Department of Emergency Medicine, Academic Office 1, Mail Stop C-326, 12631 E. 17th Ave, Aurora, CO, 80045, USAUniversity of Colorado, Department of Emergency Medicine, Academic Office 1, Mail Stop C-326, 12631 E. 17th Ave, Aurora, CO, 80045, USAColorado School of Public Health, Department of Biostatistics and Informatics, Fitzsimons Building, 4th Floor, Mail Stop B119 13001 E. 17th Place, Aurora, CO, 80045, USAUniversity of Colorado, Department of Emergency Medicine, Academic Office 1, Mail Stop C-326, 12631 E. 17th Ave, Aurora, CO, 80045, USAStellenbosch University, Division of Surgery, Department of Surgical Sciences, Francie Van Zijl Drive, Parow, Cape Town, 7500, South AfricaStellenbosch University, Division of Forensic Medicine, Department of Pathology, P.O. Box 241, Cape Town 8000, South AfricaCollaborative for Emergency Care in Africa, 8A Innesfree Way, Constantia, Cape Town 7806, South AfricaWestern Cape Government Health and Wellness, Emergency Medical Services, ESC Private Bag x 24, Bellville, Cape Town 7535, South AfricaWestern Cape Government Health and Wellness, P.O. Box 2060, Cape Town 8000, South AfricaWestern Cape Government Health and Wellness, P.O. Box 2060, Cape Town 8000, South AfricaWestern Cape Government Health and Wellness, P.O. Box 2060, Cape Town 8000, South AfricaWestern Cape Government Health and Wellness, P.O. Box 2060, Cape Town 8000, South AfricaWestern Cape Government Health and Wellness, P.O. Box 2060, Cape Town 8000, South AfricaStellenbosch University, Division of Emergency Medicine, Department of Family and Emergency Medicine, P.O. Box 17, Stellenbosch, Cape Town, 7599, South AfricaStellenbosch University, Division of Surgery, Department of Surgical Sciences, Francie Van Zijl Drive, Parow, Cape Town, 7500, South AfricaUniversity of Colorado, Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, Academic Office 1, Mail Stop C-326, 12631 E. 17th Ave, Aurora, CO, 80045, USAUniversity of Colorado, Department of Emergency Medicine, Academic Office 1, Mail Stop C-326, 12631 E. 17th Ave, Aurora, CO, 80045, USA; University of Colorado, Department of Anesthesiology, Aurora, CO, USA; US Army Medical Center of Excellence, JBSA Fort Sam Houston, Texas, USAUniversity of Colorado, Department of Emergency Medicine, Academic Office 1, Mail Stop C-326, 12631 E. 17th Ave, Aurora, CO, 80045, USAUniversity of Colorado, Department of Emergency Medicine, Academic Office 1, Mail Stop C-326, 12631 E. 17th Ave, Aurora, CO, 80045, USAIntroduction: Non-compressible torso haemorrhage (NCTH), resulting from penetrating trauma to the chest, abdomen, or pelvis, places patients at high risk of death. The objectives of this study are to characterize the injury profile of patients with penetrating NCTH who receive care within a tiered public trauma system in South Africa and to identify factors associated with mortality. Methods: This is a secondary analysis of clinical data collected from Sept-2021 through Dec-2023 across 6 hospitals, 4 ambulance bases, and 2 mortuaries in the Western Cape Province that form a cohesive trauma referral pathway. The study included patients age ≥18 years with penetrating NCTH who arrived at the hospital within 3 h and received blood products within 6 h of injury. NCTH was defined as Abbreviated Injury Scale (AIS) ≥ 2 to chest, abdomen or pelvis, with a systolic blood pressure ≤ 100 mm Hg. Data were analysed using multivariable logistic regression and Cox proportional hazards modelling. Results: There were 202 patients with penetrating NCTH; median age was 29 years, 94 % male, injured by stab wounds (66 %) and gunshot wounds (31 %). Most patients (85 %) sustained injuries to the chest, 33 % to the abdomen, and 1.5 % to the bony pelvis. In a multivariable logistic regression model, elevated Triage Early Warning Score (TEWS ≥7) (OR 4.45, 95 % CI 1.58–13.90), elevated New Injury Severity Score (NISS >25) (OR 4.35, 95 % CI 1.45–16.30), anatomic injury to the abdomen/pelvis (OR 2.76, 95 % CI 1.03–7.74), and receipt of acute airway intervention (OR 4.97, 95 % CI 1.94–13.20) were significantly associated with 7-day in-hospital mortality. Conclusion: Among patients with penetrating injuries to the torso, high triage scores, high injury severity, early airway interventions, and penetrating abdominal trauma were associated with elevated mortality risk.http://www.sciencedirect.com/science/article/pii/S2211419X25000059Non-compressible torso haemorrhagePenetrating traumaMortality risk factors |
| spellingShingle | Smitha Bhaumik Adane F. Wogu Lani Finck Maria Jamison Mengli Xiao Julia Finn Hendrick Lategan Janette Verster Shaheem de Vries Craig Wylie Lesley Hodson Mohammet Mayet Leigh Wagner L'Oreal Snyders Karlien Doubell Elaine Erasmus George Oosthuizen Christiaan Rees Steven G Schauer Julia Dixon Nee-Kofi Mould-Millman Factors associated with mortality among patients with penetrating non-compressible torso hemorrhage in South Africa: A retrospective cohort study African Journal of Emergency Medicine Non-compressible torso haemorrhage Penetrating trauma Mortality risk factors |
| title | Factors associated with mortality among patients with penetrating non-compressible torso hemorrhage in South Africa: A retrospective cohort study |
| title_full | Factors associated with mortality among patients with penetrating non-compressible torso hemorrhage in South Africa: A retrospective cohort study |
| title_fullStr | Factors associated with mortality among patients with penetrating non-compressible torso hemorrhage in South Africa: A retrospective cohort study |
| title_full_unstemmed | Factors associated with mortality among patients with penetrating non-compressible torso hemorrhage in South Africa: A retrospective cohort study |
| title_short | Factors associated with mortality among patients with penetrating non-compressible torso hemorrhage in South Africa: A retrospective cohort study |
| title_sort | factors associated with mortality among patients with penetrating non compressible torso hemorrhage in south africa a retrospective cohort study |
| topic | Non-compressible torso haemorrhage Penetrating trauma Mortality risk factors |
| url | http://www.sciencedirect.com/science/article/pii/S2211419X25000059 |
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