{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T03:03:13Z","timestamp":1784602993364,"version":"3.55.0"},"reference-count":53,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T00:00:00Z","timestamp":1745280000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43TW007292"],"award-info":[{"award-number":["D43TW007292"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Trauma is a significant cause of morbidity and mortality, disproportionately affecting low\u2010 and middle\u2010income countries (LMICs). Data from high\u2010income countries (HIC) show an evolution of Trunkey's trimodal distribution of at\u2010scene, first 48\u00a0h and after 7\u00a0days mortality to bimodal distribution caused by the flattening of the third peak. The mortality distribution in LMICs is not well described. This paper aims to temporally characterize in\u2010patient trauma\u2010related deaths and identify predictors of this mortality among adults in Pakistan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from December 2021 to February 2023 were extracted from a multicenter, prospective trauma registry in Karachi, Pakistan. Data on demographics, injury details including injury severity scores (ISS), inhospital care, and outcomes for admitted adult (\u2265 18\u00a0years) patients not referred from another facility were extracted. The primary outcome was in\u2010patient mortality categorized as within 48\u00a0h, after 48\u00a0h but within 7\u00a0days and after 7\u00a0days of injury. Multivariable analyses were done using multiple cox\u2010regression to assess the association of patient and injury characteristics with early (&lt; 48\u00a0h) and late mortality (&gt; 48\u00a0h).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We enrolled 1596 patients. The majority were males (80.70%), aged 18\u201340\u00a0years (55.33%). Half of the patients were admitted with moderate ISS (45.49%). Of these, 293 died (18.36%). Deaths were mainly due to road traffic crashes (66.55%) and head injury (84.98%). An equal proportion of mortality was observed in the &lt; 48\u00a0h and day 2\u20137 groups. One vague mortality peak was also identified at &gt; 7\u00a0days (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a0115). The adjusted hazard ratio for early mortality was 15% higher (95% CI 1.13, 1.18) for every one\u2010unit increase in the ISS score. The presence of multiple co\u2010morbidities (AHR\u00a0=\u00a04.95 95% CI 1.31, 18.68) and head injury (AHR\u00a0=\u00a015.25 95% CI 3.82, 60.81) were associated with late mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In conclusion, our trauma mortality pattern aligns partially with Trunkey's 1983 trimodal distribution, showing a persistent late mortality attributed to deaths from complications. This highlights an urgent need for improvements in trauma care to reduce late\u2010stage mortality. Further in\u2010depth analysis is required to understand the underlying mortality drivers among admitted patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/wjs.12592","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T09:59:59Z","timestamp":1745315999000},"page":"1643-1653","source":"Crossref","is-referenced-by-count":1,"title":["Bimodal, But Not the Same: Persistent Late Peaks in Trauma Mortality"],"prefix":"10.1002","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7246-5489","authenticated-orcid":false,"given":"Muhammad Bazil","family":"Musharraf","sequence":"first","affiliation":[{"name":"Centre of Excellence for Trauma and Emergencies The Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0790-6644","authenticated-orcid":false,"given":"Komal Abdul","family":"Rahim","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Trauma and Emergencies The Aga Khan University  Karachi Pakistan"},{"name":"Dean's Office The Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kantesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Trauma and Emergencies The Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijal Akhter","family":"Sheikh","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Trauma and Emergencies The Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheza","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Weill Cornell Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma Altaf","family":"Hussain Merchant","sequence":"additional","affiliation":[{"name":"Dean's Office The Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Shaukat","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Robert Stempel College of Public Health Florida International University  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huba","family":"Atiq","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Trauma and Emergencies The Aga Khan University  Karachi Pakistan"},{"name":"Department of Emergency Medicine The Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanweer","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Jinnah Postgraduate Medical Centre  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saima","family":"Mushtaq","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Jinnah Postgraduate Medical Centre  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adil Hussain","family":"Haider","sequence":"additional","affiliation":[{"name":"Dean's Office The Aga Khan University  Karachi Pakistan"},{"name":"Department of Surgery and Community Health Sciences The Aga Khan University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junaid Abdul","family":"Razzak","sequence":"additional","affiliation":[{"name":"Centre of Excellence for Trauma and Emergencies The Aga Khan University  Karachi Pakistan"},{"name":"Department of Emergency Medicine Weill Cornell Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"key":"e_1_2_12_2_1","unstructured":"WHO \u201cInjuries and Violence \u201d (2023) [09\/04\/2025] https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/injuries\u2010and\u2010violence."},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/nejm199105023241806"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2015.08.031"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/pubmed\/fdae054"},{"key":"e_1_2_12_6_1","volume-title":"Households, population, household size and annual growth rate","author":"PBS","year":"2023"},{"key":"e_1_2_12_7_1","unstructured":"\u201cAKUH Receives Joint Commission International Reaccreditation\u201d https:\/\/hospitals.aku.edu\/pakistan\/AboutUs\/News\/Pages\/akuh\u2010receives\u2010joint\u2010commission\u2010international\u2010accreditation\u2010.aspx."},{"key":"e_1_2_12_8_1","volume-title":"Institute of Trauma and Injury Management","author":"NSW Trauma Registry System"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13690\u2010024\u201001385\u20103"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068\u2010011\u20100168\u20104"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/08850666231225607"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/ta.0000000000003662"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2010.04.012"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2018.02.013"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc12851"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.4103\/1947\u20102714.141632"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010014\u20102705\u2010x"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000060261.10597.5c"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313480407000418"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000153935.18997.14"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002\u20109610(80)90431\u20106"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2005.05.003"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2003.09.003"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/08998280.2010.11928649"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2007.05.022"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148844"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.53730\/ijhs.v7ns1.14288"},{"issue":"1","key":"e_1_2_12_28_1","first-page":"81","article-title":"Retrospective Autopsy Based Analysis of Nature and Prevalence of Fatal Injuries in Lahore Pakistan","volume":"1","author":"Rabia S.","year":"2020","journal-title":"Journal of Surgery and Medicine"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068\u2010008\u20108080\u20102"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102019\u2010029187"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049\u2010017\u20100354\u20104"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1137"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13049\u2010014\u20100052\u20104"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010020\u201000325\u20100"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-89508-6"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00264\u2010009\u20100746\u20109"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0194749"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/000313481908500130"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijsu.2009.10.012"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1072\u20107515(98)00082\u20109"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0212095"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.1993.01420170107016"},{"key":"e_1_2_12_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0361\u20101124(74)80005\u20105"},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13017\u2010020\u201000330\u20103"},{"key":"e_1_2_12_45_1","volume-title":"700 New Motorbikes Hit City Roads Every Day, Multiply Traffic Problems","author":"Ayub I.","year":"2017"},{"key":"e_1_2_12_46_1","unstructured":"R.Haq \u201cVehicles in Pakistan: Over Half of All Households Own Motorcycles in 2019 2019\u201d https:\/\/www.riazhaq.com\/2019\/06\/vehicles\u2010in\u2010pakistan\u2010over\u2010half\u2010of\u2010all.html."},{"issue":"6","key":"e_1_2_12_47_1","article-title":"Healthcare in Pakistan: Navigating Challenges and Building a Brighter","volume":"15","author":"Muhammad Q.","year":"2023","journal-title":"Future Cureus"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1989.03430160073033"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2004.02.030"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005373\u2010199412000\u201000016"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1159\/000107097"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1080\/02699050010025768"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00508\u2010006\u20100761\u20104"},{"key":"e_1_2_12_54_1","unstructured":"M.Faul M. M.Wald L.Xu andV. G.Coronado Traumatic Brain Injury in the United States: Emergency Department Visits Hospitalizations and Deaths(2010): 2002\u20102006."}],"container-title":["World Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.12592","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/wjs.12592","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/wjs.12592","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T16:30:40Z","timestamp":1771259440000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/wjs.12592"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,22]]},"references-count":53,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1002\/wjs.12592"],"URL":"https:\/\/doi.org\/10.1002\/wjs.12592","archive":["Portico"],"relation":{},"ISSN":["0364-2313","1432-2323"],"issn-type":[{"value":"0364-2313","type":"print"},{"value":"1432-2323","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,22]]}}}