Epidemiology of Trauma Deaths

OBJECTIVE: Recognizing the impact of the 1977 San Francisco study of trauma deaths in trauma care, our purpose was to reassess those findings in a contemporary trauma system. DESIGN: Cross-sectional. MATERIAL AND METHODS: All trauma deaths occurring in Denver City and County during 1992 were reviewed; data were obtained by cross-referencing four databases: paramedic trip reports, trauma registries, coroner autopsy reports and police reports. MEASUREMENTS AND MAIN RESULTS: There were 289 postinjury fatalities; mean age was 36.8 +/- 1.2 years and mean Injury Severity Score (ISS) was 35.7 +/- 1.2. Predominant injury mechanisms were gunshot wounds in 121 (42%), motorvehicle accidents in 75 (38%) and falls in 23 (8%) cases. Seven (2%) individuals sustained lethal burns. Ninety eight (34%) deaths occurred in the pre-hospital setting. The remaining 191 (66%) patients were transported to the hospital. Of these, 154 (81%) died in the first 48 hours (acute), 11 (6%) within three to seven days (early) and 26 (14%) after seven days (late). Central nervous system injuries were the most frequent cause of death (42%), followed by exsanguination (39%) and organ failure (7%). While acute and early deaths were mostly due to the first two causes, organ failure was the most common cause of late death (61%). CONCLUSIONS: In comparison with the previous report, we observed similar injury mechanisms, demographics and causes of death. However, in our experience, there was an improved access to the medical system, greater proportion of late deaths due to brain injury and lack of the classic trimodal distribution.

[1]  A. Sauaia,et al.  Pneumonia: cause or symptom of postinjury multiple organ failure? , 1993, American journal of surgery.

[2]  E. Moore,et al.  Surgical Critical Care: The Next Challenge in Regionalized Trauma Systems , 1992 .

[3]  A. Eastman,et al.  Blood in our streets. The status and evolution of trauma care systems. , 1992, Archives of surgery.

[4]  D. Webster,et al.  Epidemiologic changes in gunshot wounds in Washington, DC, 1983-1990. , 1992, Archives of surgery.

[5]  L Adelson,et al.  The gun and the sanctity of human life; or the bullet as pathogen. , 1992, The Pharos of Alpha Omega Alpha-Honor Medical Society. Alpha Omega Alpha.

[6]  C. Cayten,et al.  Analyses of preventable deaths by mechanism of injury among 13,500 trauma admissions. , 1991, Annals of surgery.

[7]  Alexander L. Eastman,et al.  An analysis of errors causing morbidity and mortality in a trauma system: a guide for quality improvement. , 1991, The Journal of trauma.

[8]  S. Shackford,et al.  The significance of critical care errors in causing preventable death in trauma patients in a trauma system. , 1991, The Journal of trauma.

[9]  T Gennarelli,et al.  A new characterization of injury severity. , 1990, The Journal of trauma.

[10]  S. Shackford,et al.  Epidemiology and pathology of traumatic deaths occurring at a Level I Trauma Center in a regionalized system: the importance of secondary brain injury. , 1989, The Journal of trauma.

[11]  S. Shackford,et al.  Assuring quality in a trauma system--the Medical Audit Committee: composition, cost, and results. , 1987, The Journal of trauma.

[12]  W G Baxt,et al.  Impact of a trauma system on outcome of severely injured patients. , 1987, Archives of surgery.

[13]  P Rosen,et al.  Prehospital advanced trauma life support for critical penetrating wounds to the thorax and abdomen. , 1985, The Journal of trauma.

[14]  D. Trunkey,et al.  Preventable trauma deaths. A review of trauma care systems development. , 1985, JAMA.

[15]  J. Ornato,et al.  Impact of improved emergency medical services and emergency trauma care on the reduction in mortality from trauma. , 1985, The Journal of trauma.

[16]  E. Faist,et al.  Multiple organ failure in polytrauma patients. , 1983, The Journal of trauma.

[17]  B. Lindblad,et al.  Patients with abdominal trauma and fatal outcome: analysis of a 30-year series. , 1983, The Journal of trauma.

[18]  W. Baxt,et al.  An autopsy study of traumatic deaths; San Diego County, 1979. , 1982, American journal of surgery.

[19]  R. Goris,et al.  Causes of death after blunt trauma. , 1982, The Journal of trauma.

[20]  W. Stahl,et al.  A five-year review of deaths following urban trauma. , 1980, The Journal of trauma.

[21]  J. G. West,et al.  Systems of trauma care. A study of two counties. , 1979, Archives of surgery.

[22]  D. Trunkey,et al.  Analysis of 425 consecutive trauma fatalities: An autopsy study , 1974 .

[23]  W. Haddon,et al.  The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. , 1974, The Journal of trauma.

[24]  R. Zollinger.  Traffic injuries; a surgical problem. , 1955, A.M.A. archives of surgery.

[25]  A. Sauaia,et al.  Early predictors of postinjury multiple organ failure. , 1994, Archives of surgery.