Hypocalcemia associated with adverse outcomes following severe traumatic injury in the Western Cape of South Africa: a secondary analysis of multicenter data from the Epidemiology and Outcomes
of Prolonged Trauma Care (EpiC) study

Hypocalcemia associated with adverse outcomes following severe traumatic injury in the Western Cape of South Africa: a secondary analysis of multicenter data from the Epidemiology and Outcomes
of Prolonged Trauma Care (EpiC) study

Global health, Hypocalcemia, Low- and middle-income countries, Resource-limited healthcare, Trauma

Abstract
Background Hypocalcemia precipitated by severe traumatic injury is well-described in the literature and has been
associated with numerous adverse outcomes including mortality, transfusion requirement, and coagulopathy severity.
The majority of studies to-date have been conducted in well-resourced clinical practice settings. Here, we describe
adverse outcomes associated with severe hypocalcemia among a cohort of individuals presenting to emergency care
following acute traumatic injury in a resource-limited setting.
Methods The present study is a secondary analysis of the Epidemiology and Outcomes of Prolonged Trauma Care
(EpiC) study, a prospective observational multicenter study of adult trauma patients in the Western Cape of South
Africa. Individuals for whom a serum calcium level was measured at the time of hospital arrival were included, and the
incidence of various adverse outcomes, including 30-day mortality, length of hospital stay, need for ICU admission,
severity of organ dysfunction (defined by Sequential Organ Failure Assessment (SOFA) score), and blood transfusion
requirement were compared across calcium strata. In total, 1989 individuals met criteria for inclusion.
Results The incidence of any hypocalcemia (ionized calcium<1.15 mmol/L) was 52%, while the incidence of severe
hypocalcemia (<1.00 mmol/L) was 5%. Adverse outcomes including 30-day mortality (4.0% vs. 2.9%), need for ICU
admission (17% vs. 5.9%), maximum total SOFA score within 7 days (4 vs. 2), and need for blood product transfusion
(35% vs. 18%), were all significantly more common in the severe hypocalcemia group as compared with others

Christiaan A. Rees1

, Jessica L. Wild2

, Mengli Xiao2

, Lani L. Finck3

, Jessica B. Oudakker4

, Hendrick J. Lategan5
,

George Oosthuizen5

, Shaheem de Vries6

, Janette Verster7

, Mohammed Mayet8

, Lesley Hodsdon8

, Karlien Doubell8
,

Leigh Wagner8

, L’Oreal Snyders8

, Denise Lourens8

, Elmin Steyn5

, Julia M. Dixon3

, Steven G. Schauer9

and Nee-
Kofi Mould-Millman3*

https://doi.org/10.1186/s12245-025-00893-5

2025

Peri Irawan

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