# Trauma-related mortality in a European region with an intermediately mature trauma system: a comprehensive population-based analysis

## TL;DR

This study analyzes trauma-related deaths in Biscay, Spain, revealing two distinct patterns: high-energy injuries in young adults and low-energy falls in older adults.

## Contribution

The study identifies a dual epidemiological pattern in trauma mortality within an intermediately mature trauma system.

## Key findings

- Low-energy falls and high-energy falls were the primary injury mechanisms in older and younger populations, respectively.
- Traumatic brain injury and massive hemorrhage were the leading causes of death.
- Adapting trauma care to address both injury types could improve outcomes in aging populations.

## Abstract

Understanding the epidemiology of trauma-related mortality is essential to guide quality improvement and optimize trauma system performance. However, the absence of comprehensive regional registries often limits accurate assessment. This study aimed to characterize trauma-related deaths in Biscay (Spain), a European region with an intermediately mature trauma care system, including both prehospital and in-hospital deaths.

A retrospective, population-based observational study included all trauma-related deaths in 2019 and 2022. Data were obtained from forensic autopsy reports and cross-referenced with clinical registries from the Basque Health Service. Variables analyzed were demographics, injury mechanisms, severity scores (AIS, ISS, NISS), ASA-PS classification, medico-legal intent, and physiopathological cause of death. Years of potential life lost before age 70 (YPLL70) were calculated.

A total of 313 trauma-related deaths were recorded: 151 in 2019 and 162 in 2022. Median age was 72 years (P25–P75: 52–84), and 67% were men. Low-energy falls accounted for 41% of cases and high-energy falls for 30%. The medico-legal intent was mainly unintentional (69%), followed by suicide (29%). Traumatic brain injury (47%) and massive hemorrhage (29%) were the leading physiopathological causes. Two distinct profiles emerged: young adults sustaining high-energy trauma with severe injuries, and older adults dying after low-energy mechanisms.

This study highlights a dual epidemiological pattern of trauma-related mortality in a region with an intermediately mature trauma system. Adapting trauma care pathways to address both high- and low-energy trauma, particularly in an aging population, may improve efficiency, equity, and clinical outcomes.

The online version contains supplementary material available at 10.1007/s00068-025-03043-x.