Mortality rate and associated factors among polytrauma patients with orthopedic injuries managed at Mulago National Referral Hospital

Abstract

Background: Polytrauma remains a major cause of morbidity and mortality worldwide, with a particularly high burden in low and middle income countries like Uganda. Orthopedic injuries are among the most common and resource-intensive components of polytrauma. This study aimed to determine the in-hospital mortality rate and associated factors among polytrauma patients with orthopedic injuries managed at Mulago National Referral Hospital. Objective: To determine the mortality rate and associated factors among polytrauma patients with orthopaedic injuries managed at Mulago National Referral Hospital. Methods: A prospective cohort study was conducted between January and March 2026, enrolling 160 polytrauma patients with orthopedic injuries from the Accident and Emergency unit at MNRH. Polytrauma was defined as two or more severe injuries in at least two body regions, with at least one major musculoskeletal injury. Mortality was considered for any death occurring during hospital stay. Data collection included medical record review, head-to-toe physical examination, and follow-up until discharge, death, or study conclusion Kaplan-Meier survival analysis estimated survival probability, and logistic regression identified factors independently associated with mortality. Results: Of the 156 patients analysed (four lost to follow-up; response rate 97.5%), the median age was 32 years (IQR 25–40) and 82.1% were male. The in-hospital mortality rate was 16.03% (95% CI: 11.1%–22.6%), with over half of all deaths occurring within the first 24 hours of admission. Kaplan-Meier analysis showed a 7-day survival probability of 81.8%, with 96% of deaths occurring within the first seven days. Multivariate analysis identified advanced age (≥60 years, AOR=5.6), GCS <8 on admission (AOR=19.6), presence of tachypnea at admission (AOR=16.7), and unmet blood transfusion indication (AOR=13.7) as factors independently associated with mortality. Conclusion: Polytrauma patients with orthopaedic injuries at MNRH experience high in-hospital mortality, with virtually all deaths occurring within the first seven days. Mortality was associated with advanced age, severe neurological compromise, respiratory distress, and unmet transfusion need. These findings highlight the need for early resuscitation, age-specific care protocols, timely transfusion, and enhanced patient support to improve outcomes. Keywords: Polytrauma, Orthopedic injuries, Mortality, Uganda.