Trends in Etiology and Mortality in Severe Polytrauma Patients with Traumatic Brain Injury: A 25-Year Retrospective Analysis

Background: Polytrauma is a leading cause of mortality and disability worldwide. Despite a decline in trauma-related deaths over recent decades, the specific factors driving this trend remain unclear. Traumatic brain injury (TBI) is the primary cause of death and long-term disability among polytraumatized patients, making it a key determinant in outcomes. Methods: This retrospective observational study analyzed a prospectively collected trauma registry over a 25-year period (1993–2018) at Gregorio Marañón University General Hospital (Madrid, Spain). The study included adult patients with polytrauma and associated TBI. Epidemiological, clinical, and outcome data were analyzed globally and across four time periods to assess trends. Results: Among 768 patients with PTBI, the mean age was 43 years (±20), with 71% being male. Most had closed TBIs (96%) and severe injuries to the head, chest, and extremities (median ISS/NISS: 27/34). Emergency surgery was required in 51% of cases, and 84% were admitted to intensive care units. Over time, patient age, comorbidities, and prehospital care increased, while ISS/NISS scores and early mortality decreased. Mortality dropped significantly—especially deaths within the first 24 hours—primarily due to improved hemorrhage control. However, TBI-related mortality remained stable at 28%. Conclusions: The incidence of polytrauma declined over time, notably due to fewer traffic-related injuries—likely reflecting ad-vances in safety legislation and prevention. Despite an aging and more comorbid patient population, overall mortality decreased, highlighting the impact of improved trauma care. TBI continues to be the leading cause of death and a persistent clinical challenge.