Two new studies published in JAMA Network Open by Weill Cornell Medicine researchers reveal that traumatic brain injuries in Karachi, Pakistan, carry high 12-month mortality rates—reaching nearly 60% for moderate injuries and 88% for severe cases—highlighting critical gaps in post-discharge care and emergency trauma systems.
Severe and Moderate Traumatic Brain Injuries Carry High Mortality Rates
Researchers analyzing data from a trauma registry covering two care centers in Karachi from December 2021 to May 2024 uncovered mortality outcomes that far exceed those recorded in high-income countries. The findings stem from two separate papers published in JAMA Network Open, with the first focusing on patients admitted with moderate to severe head trauma.
Clinicians gauge alertness following a head injury using the Glasgow Coma Scale (GCS), a 15-point measure tracking eye, verbal, and motor responses. Severe traumatic brain injury is marked by a score of 3 to 8, indicating that patients cannot follow commands, respond to pain, or maintain a clear airway. Moderate injury sits at a score of 9 to 12, where individuals may remain confused but can still obey simple commands.
The first study examined 819 registry patients, comprising 45% with moderate injuries and 55% with severe trauma. While patients with severe scores faced the greatest risk, researchers were struck by the severe toll among patients with moderate injuries. At the 12-month mark, mortality reached nearly 60% for moderate cases and climbed to almost 88% for severe injuries. By comparison, corresponding mortality rates in high-income nations stand at 9% and 30%.
“We found that TBIs are responsible for a high number of trauma-related deaths in Pakistan, even with more mild to moderate injuries, which we were not expecting. Patients are falling through gaps in the trauma care system before, during and especially after hospitalization.”
Dr. Junaid Razzak, senior author, professor of emergency medicine at Weill Cornell and emergency medicine physician at NewYork-Presbyterian/Weill Cornell Medical Center
Reassessing Mild Traumatic Brain Injuries and Vulnerability After Discharge
A second study published Aug. 13 examined 602 registry patients diagnosed with mild traumatic brain injury, defined as a GCS score of 13 to 15. Although these patients typically remain awake and able to follow commands, many experience transient confusion or memory loss during recovery.
The findings showed that not all mild injuries share an equal prognosis. Patients at the lower end of the mild GCS range experienced substantially higher mortality and poorer quality of life than those who scored a full 15. Researchers noted that premature discharge—with patients staying an average of approximately two days—alongside potential misclassification of more serious injuries as mild may have driven these poorer outcomes. Across all groups in the second study, the 12-month mortality rate hit 14%, a figure notably higher than comparable data from wealthy nations.
Many fatalities occurred during the critical first month after leaving the hospital, pointing to a dangerous transition period as patients returned home. Across both studies, investigators identified older age, the absence of surgical intervention, and greater initial injury severity as key factors linked to an elevated risk of death.
“My hunch is that even people with mild disabilities, who are already living at the edge of poverty, fall below the poverty line when they can’t work or perform basic tasks, Then their access to basic healthcare and ability to take care of themselves drops significantly.”
Dr. Junaid Razzak, senior author, professor of emergency medicine at Weill Cornell
Fixing a Broken Chain of Survival in Resource-Limited Settings
Road traffic accidents drive most traumatic brain injuries in low- and middle-income countries, yet long-term patient trajectories in these regions have historically remained poorly understood. The two new studies in JAMA Network Open provide a granular look at recovery over a full year, suggesting that many deaths and lasting disabilities could be avoided with structured system-wide reforms.
Proposed solutions from the Weill Cornell Medicine researchers include expanding rehabilitation services, strengthening post-discharge monitoring through telehealth or regular remote follow-ups, and securing faster access to appropriate medical intervention. Dr. Razzak emphasized that treatment delivered within the initial 48 hours dictates long-term recovery prospects.
“A broken ‘chain of survival’ exists, in which bystanders don’t know how to respond to an accident, ambulance drivers don’t know which hospitals have open beds and emergency room healthcare providers race against the clock, Treatment in the first 48 hours is critical for better outcomes.”
Dr. Junaid Razzak, senior author, professor of emergency medicine at Weill Cornell
Future investigations led by Dr. Razzak will examine how trauma care networks can be re-engineered to route patients efficiently to adequately equipped facilities, addressing the persistent vulnerabilities that claim lives long after patients leave hospital wards.
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