• Gerard M O'Reilly, Afsana Afroz, Kate Curtis, Biswadev Mitra, Yesul Kim, Emma Solly, Courtney Ryder, Kate Hunter, Delia V Hendrie, Nick Rushworth, Jin Tee, and Mark C Fitzgerald.
• National Trauma Research Institute, Alfred Health, Melbourne, Victoria, Australia.
• Emerg Med Australas. 2025 Feb 1; 37 (1): e14562e14562.

ObjectivesTo establish the determinants of death in hospital for patients with moderate to severe traumatic brain injury (TBI) in Australia.Design, Setting, ParticipantsRetrospective analysis of Australia New Zealand Trauma Registry (ANZTR) data. Cases were included if they presented to a participating hospital between 1 July 2015 and 30 June 2020 and had an Abbreviated Injury Severity (AIS) score - head greater than 2.Main Outcome MeasuresDeath in hospital.ResultsThere were 16 350 patients. Their mean age was 51 years and 71% were male. After adjusting for measures of injury severity, there was an increased odds of in-hospital death for patients whose injury occurred outside daylight hours or first mode of transport was road ambulance, who were not transferred from another hospital, had an endotracheal tube placed prior to definitive hospital arrival or received their definitive hospital care outside Victoria.ConclusionAmong people presenting to a major trauma hospital in Australia following moderate to severe TBI, there were multiple factors independently associated with death in hospital. The potentially modifiable determinants of in-hospital death included out-of-hours access to emergency care, mode of transfer from the scene of the injury, prior facility care and pre-definitive hospital endotracheal intubation.© 2025 The Author(s). Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

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