Clinical Outcomes of Polytrauma Patients Admitted to Critical Care Units in Lower-Middle-Income Countries: A Narrative Review

Abstract

Background: Polytrauma and severe multisystem injury impose substantial demands on critical-care services, particularly in resource-constrained settings where prehospital systems, referral pathways, surgical capacity, blood-product availability, specialist services, and intensive-care resources may be unevenly distributed. Reported outcomes are difficult to compare because published studies include heterogeneous polytrauma, severe-trauma, trauma-ICU, and broader hospital trauma populations. Objective: To narratively synthesize clinical outcomes and major outcome-associated factors among critically ill patients with polytrauma and severe multisystem trauma in lower-middle-income and comparable resource-constrained settings, with particular emphasis on mortality, survival, critical-care utilization, complications, neurological injury, physiological instability, and time-critical trauma care. Methods: A narrative review approach was used to integrate primary trauma studies, multicentre registry evidence, complication-focused critical-care studies, and relevant review-level evidence. The synthesis focused on ICU and in-hospital mortality, survival, ICU and hospital length of stay, mechanical ventilation, major complications, and neurological or functional outcomes. Findings were organized thematically and interpreted within their original populations; quantitative pooling was not undertaken because of substantial clinical and methodological variability in case definitions, injury severity, ICU admission criteria, and outcome measurement. Results: Trauma-specific ICU cohorts reported substantial mortality, including 32.7% in Tanzania, 31.3% in a Pakistani surgical ICU, and 40.5% (248/613) in a multicentre Northwest Ethiopian cohort, whereas a broader Indian trauma registry reported 30-day in-hospital mortality of 12.4%. Low Glasgow Coma Scale score, severe neurological injury, hypotension, physiological instability, complications, and delays in time-critical care were repeatedly associated with adverse outcomes. Mechanical ventilation requirements ranged markedly according to population severity, and ventilator-associated pneumonia affected 36.2% of patients in one trauma ICU cohort and was associated with prolonged ventilation and ICU stay. Evidence concerning longer-term neurological and functional recovery was limited. Conclusion: Mortality and morbidity after severe trauma remain substantial but cannot be represented by a single estimate across heterogeneous settings. Outcomes reflect the interaction of injury severity with prehospital, emergency, surgical, and critical-care processes. Standardized multicentre trauma registries incorporating complications, functional recovery, and time-to-care measures are needed to identify modifiable system failures and guide context-appropriate improvements in trauma care