Trauma-Related Mortality in a European Region with an Intermediately Mature Trauma System: A Comprehensive Population-Based Analysis

Understanding the epidemiology and caseload of trauma is a necessary first step in designing effective continuous quality improvement strategies. However, obtaining precise statistics is challenging in absence of a specific and comprehensive registry.This retrospective observational study analyzed all trauma-related deaths in Biscay (Spain) in 2019 and 2022, a region with an intermediately mature trauma system. The objective was to provide a comprehensive characterization of trauma mortality, including prehospital deaths, to guide improvements in trauma care.A total of 313 deaths were recorded. The mean age was 67 years, with trauma accounting for 33% of all deaths among men aged 20–29. The most frequent injury mechanisms were low-energy falls (40.9%), predominantly among the elderly, and high-energy falls (29.7%). Non-penetrating injuries accounted for 94.2% of cases. Medico-legal etiology was predominantly accidental (69%). Suicides represented 28.8% of deaths, 42.2% of which occurred among individuals aged 15–64. Traumatic brain injury and massive hemorrhage were the leading physiopathological causes of death. Most victims had a single anatomical region with severe injury. According to ISS values, 17.6% of deaths were classified as potentially preventable and 49.8% as possibly preventable.The findings reveal a dual profile of trauma-related mortality: on one hand, young adults affected by high-energy trauma with severe injuries; and on the other, older adults, in whom low-energy trauma with less severe injuries predominates but has a major impact due to frailty. This analysis highlights an opportunity to optimize the trauma care pathway and adapt it to the challenges posed by demographic change.