Critical trauma burden and surgical readiness gaps in Tanzania: a prospective observational study using a web-based trauma registry

Background: Trauma remains the leading cause of preventable mortality, yet real-time data on surgical care systems remain limited. We evaluated trauma care pathways and system gaps at the Muhimbili Orthopedic Institute (MOI) in Tanzania. Methods: This prospective observational cohort included consecutive alive trauma patients presenting between June 2023 and December 2024, captured in a secure web-based registry. Patients were categorized by transfer status and injury severity using the Kampala Trauma Score (KTS≤6 vs >6). The primary outcome was 14-day in-hospital mortality; secondary outcomes included surgery, complications, and length of stay. Multivariable and Cox models were used to identify predictors of mortality, with sensitivity analyses for missing data. Results: Among 8440 patients, 210/8440 (2.5%) records were implausible and treated as missing. The median age was 30 years; 6393/8440 (75.8%) were male, and 5142/8440 (60.9%) transfers. Despite high road traffic injuries (4913/8440;58.2%), low helmet/seatbelt (1856/4913; 37.8%) usage. Median prehospital time was longer for transfers than direct arrivals (425 [IQR 231–721] vs 120 [75–240] minutes; median time to definitive care 270 minutes (IQR 180–420). Over 992/8,440(11.8%) had KTS≤6. Surgery occurred in 5259/8440 (62.3%), with complications in 1099/5259 (20.9%), more frequent after weekend than weekday surgery [153/1008 (15.2%) vs 310/2568 (12.1%); P = 0.04], and mostly Clavien–Dindo grade I–II (812/1099; 74%). Of 3051/8440(36.2%) patients with 24-hour dispositions, 1787/3051 (58.6%) were discharged from emergency department, while 255/3051 (8.4%) died. Among hospitalized (5389/8440; 63.9%), 3807/5389 (70.6%) were discharged, 723/5389(13.4%) died within 14 days, and 859/5389(15.9%) were followed beyond 14 days, with 131/859 (15.3%) deaths by 30 days. Overall, in-hospital mortality was 1109/8440 (13.1%); mortality was independently associated with KTS≤6 (aOR 4.12; 95% CI 3.21–5.28) and transferred (aOR 1.85; 95% CI 1.50–2.28); median hospital stay was 6 days (IQR 4–13). Conclusion: High trauma mortality reflects delayed transfer, definitive management, and limited care capacity. This prospective web-based registry enabled identification of actionable system gaps, supporting targeted improvements in trauma care in resource-limited settings.