Structural clinical and epidemiological study of factors influencing mortality in patients with combined thoracoabdominal trauma

Aim. To determine the influence of injury severity, sex, and type of trauma on the clinical and epidemiological structure of mortality in patients with combined thoracoabdominal trauma. Materials and methods. A single-center retrospective cohort study was conducted based on an electronic registry of 2,009 medical records of patients with combined chest and abdominal trauma treated in a trauma unit in Kyiv in 2002–2011. Injury severity was quantitatively assessed using the Military Field Surgery Injury Severity scale. The cohort of 933 deceased patients was stratified into clinical and epidemiological clusters using k-means cluster analysis. Associations between cluster membership, sex, and type of trauma were assessed using Pearson’s chi-square test and Cramer’s V; adjusted standardized residuals were used to identify local deviations. Statistical significance was set at p<0.05. Results. Significant structural heterogeneity of the clusters according to anatomical injury profile was identified (χ²(20)=77.38; p<0.001), with a moderate association (Cramer’s V=0.418). The clusters demonstrated distinct anatomical profiles: predominance of thoracic injuries in Cluster I, pelvic injuries in Cluster II, abdominal injuries in Cluster III, and cranial injuries in Clusters IV and V. Men predominated in the overall cohort (73.4%); however, no significant association between sex and cluster membership was found (χ²=6.851; df=4; p=0.144; Cramer’s V=0.086). Similarly, type of trauma was not significantly associated with cluster membership (χ²=17.424; df=12; p=0.134; Cramer’s V=0.079). Conclusions. The mortality cohort demonstrated significant heterogeneity in anatomical injury profiles, supporting the validity of clinical and epidemiological cluster stratification. Sex and type of trauma showed no statistically significant overall association with cluster structure, suggesting that anatomical injury severity is a more important determinant of the observed mortality patterns.