{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T01:54:09Z","timestamp":1781402049897,"version":"3.54.1"},"reference-count":26,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"accepted":{"date-parts":[[2026,1,15]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Classic trauma mortality models, including Trunkey\u2019s trimodal distribution and Wyatt\u2019s 1995 Lothian study, reported most major trauma deaths occurring within the first hour after injury. Recent UK data suggest a shift in trauma demographics towards older patients and low-energy mechanisms, which may alter established mortality timelines. This study aimed to provide the first update of trauma fatality time frames in Scotland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective observational study of all patients aged \u226512 years who died from major trauma (Injury Severity Score \u226516) in the Lothian region of Scotland between 1 February 2022 and 31 January 2024. Data were obtained from the Edinburgh University Forensic Pathology database and the Scottish Trauma Audit Group registry. Time from injury to death was categorised as: within 1\u2009hour, 1\u20134\u2009hours or &gt;4\u2009hours. Mechanism, intent, age and sex were also analysed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 208 major trauma deaths were identified. Overall, 67 (32.2%) occurred within 1\u2009hour, 15 (7.2%) between 1 and 4\u2009hours and 126 (60.6%) after 4\u2009hours. Same-level falls accounted for 68 deaths (33%). Patients aged &gt;65 years comprised 54% of the cohort; in this subgroup, late deaths were most common.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The distribution of trauma deaths in Lothian has shifted markedly since 1995, with fewer immediate deaths and more late in-hospital fatalities, driven largely by same-level falls in older adults. These findings underline the need for trauma systems to focus on targeted prevention and management strategies for elderly patients at risk of late complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/ip-2025-045967","type":"journal-article","created":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T01:35:11Z","timestamp":1781400911000},"page":"ip-2025-045967","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Changing time of death after major trauma in Scotland"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7702-1726","authenticated-orcid":false,"given":"Declan Robert","family":"Bradley","sequence":"first","affiliation":[{"name":"University of Edinburgh Medical School, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Kerslake","sequence":"additional","affiliation":[{"name":"Emergency Department, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"BouHaidar","sequence":"additional","affiliation":[{"name":"Forensic Pathology, Division of Pathology, University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,13]]},"reference":[{"key":"2026061318350454000_ip-2025-045967v1.1","doi-asserted-by":"crossref","unstructured":"Lopez AD , Mathers CD , Ezzati M , et al . Global Burden of Disease and Risk Factors. Washington (DC): The International Bank for Reconstruction and Development \/ The World Bank, 2006.","DOI":"10.1596\/978-0-8213-6262-4"},{"key":"2026061318350454000_ip-2025-045967v1.2","unstructured":"Scotland PH . Audit of trauma management in scotland. Scottish Trauma Audit Group; 2024."},{"key":"2026061318350454000_ip-2025-045967v1.3","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2015-205265"},{"key":"2026061318350454000_ip-2025-045967v1.4","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/bjs5.80","article-title":"Major trauma in older persons","volume":"2","author":"Beck","year":"2018","journal-title":"BJS Open"},{"key":"2026061318350454000_ip-2025-045967v1.5","doi-asserted-by":"crossref","unstructured":"Trunkey D . Trauma. 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Reporting deaths to the procurator fiscal, information and guidance for medical practioners. Crown Office and Procurator Fiscal Service; 2019. Available: https:\/\/www.copfs.gov.uk\/publications\/reporting-deaths\/"},{"key":"2026061318350454000_ip-2025-045967v1.11","unstructured":"The Scottish Trauma Audit Group . STAG. n.d. Available: https:\/\/www.stag.scot.nhs.uk\/"},{"key":"2026061318350454000_ip-2025-045967v1.12","first-page":"349","volume-title":"Changing Epidemiology of Trauma Deaths Leads to a Bimodal Distribution","volume":"23","author":"Gunst","year":"2010"},{"key":"2026061318350454000_ip-2025-045967v1.13","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1016\/j.jss.2015.08.031","article-title":"Timing of death after traumatic injury--a contemporary assessment of the temporal distribution of death","volume":"200","author":"Valdez","year":"2016","journal-title":"J Surg Res"},{"key":"2026061318350454000_ip-2025-045967v1.14","doi-asserted-by":"crossref","unstructured":"Sobrino J , Shafi S . Baylor university medical center proceedings. 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