Trauma fatalities: Time and location of hospital deaths
ABSTRACT Analysis of the epidemiology, temporal distribution, and place of traumatic hospital deaths can be a useful tool in identifying areas for research, education, and allocation of resources.
Trauma registry-based study of all traumatic hospital deaths at a Level I urban trauma center during the period 1993 to 2002. The time and hospital location where deaths occurred were analyzed according to mechanism of injury, age, Glasgow Coma Score, and body areas with severe injury (Abbreviated Injury Scale [AIS] >/= 4). Logistic regression analysis was used to identify risk factors associated with death at various times after admission.
During the study period there were 2,648 hospital trauma deaths. The most common body area with critical injuries (AIS >/= 4) was the head (43%), followed by the chest (28%) and the abdomen (19%). Overall, 37% of victims had no vital signs present on admission. Chest AIS >/= 4, penetrating trauma, and age greater than 60 years were significant risk factors associated with no vital signs on admission. Patients with severe chest trauma (AIS >/= 4) reaching the hospital alive were significantly more likely to die within the first 60 minutes than were patients with severe abdominal or head injuries (17% versus 11% versus 7%). In patients reaching the hospital alive, the time and place of death varied according to mechanism of injury and injured body area. Deaths caused by severe head trauma peaked at 6 to 24 hours, and deaths caused by severe chest or abdominal trauma peaked at 1 to 6 hours after admission.
The temporal distribution and location of trauma deaths are influenced by the mechanism of injury, age, and the injured body area. These findings may help in focusing research, education, and resource allocation in a more targeted manner to reduce trauma deaths.
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ABSTRACT: Collider bias, or stratifying data by a covariate consequence rather than cause (confounder) of treatment and outcome, plagues randomized and observational trauma research. Of the seven trials of prehospital hypertonic saline in dextran (HSD) that have been evaluated in systematic reviews, none found an overall between-group difference in survival, but four reported significant subgroup effects. We hypothesized that an avoidable type of collider bias often introduced inadvertently into trauma comparative effectiveness research could explain the incongruous findings.Injury 01/2015; 46(5). DOI:10.1016/j.injury.2015.01.043 · 2.46 Impact Factor
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ABSTRACT: Conocer la epidemiología, cronograma y causas de mortalidad tardía en los politraumatizados graves.DiseñoObservacional prospectivo de cohortes integrado en un registro provincial de trauma.ÁmbitoProvincia de Guipúzcoa. Unidad de cuidados intensivos (UCI) hospital terciario.PacientesTodos los traumatizados graves: Injury Severity Score (ISS) > 15, ingresados en UCI entre el 1 de enero de 1995 y el 31de diciembre de 2009, fallecidos tardíamente (> 7 días).VariablesEpidemiológicas, analíticas, hemodinámicas, transfusionales y escalas de gravedad Abbreviated Injury Scale (AIS) e ISS.ResultadosPacientes: 2.003. ISS: 24,3 ± 14,2. Exitus: 405 (20%). Fallecidos >7 días: 102 (25,2%) con 9 años más y 18 puntos menos de ISS que los fallecidos a las 48 h. Lesiones más graves: AIS-cabeza-columna cervical ≥ 4 (52%); AIS-abdomen ≥ 4 (19,65) AIS-tórax ≥ 4 (11,7%); AIS-extremidades ≥ 4 (4,9%). Causas de fallecimiento: 1) muerte encefálica (14,7%); 2) fracaso multiorgánico (FMO) (67,6%) presente en 2 contextos lesionales: a) TCE grave en estado vegetativo y lesiones agudas de médula espinal (LAME) cervicales altas con tetraplejía (35,3%) y b) lesiones no neurológicas (32,3%), con alta prevalencia de shock hipovolémico, politransfusión y coagulopatía; 3) una variada miscelánea (10,7%): encefalopatía hipóxica, embolia pulmonar e ictus masivo; 4) no evaluables (7%).ConclusionesLa edad, la gravedad, y las características lesionales, influyen en la distribución temporal y causalidad de la mortalidad tardía. La muerte encefálica sigue siendo prevalente. El FMO es la causa más frecuente. Estos hallazgos pueden ayudar a una mejor planificación de los recursos estructurales y educativos, y a la reducción de la morbi-mortalidad del trauma.Medicina Intensiva 08/2013; 37(6):383-390. DOI:10.1016/j.medin.2012.07.001 · 1.24 Impact Factor
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ABSTRACT: BACKGROUND The purpose of this study was to characterize the cause of death in severely injured trauma patients to define potential responses to resuscitation. METHODS Prospective analysis of 190 critically injured patients who underwent massive transfusion protocol (MTP) activation or received massive transfusion (>10 U of packed red blood cells [RBC] per 24 hours). Cause of death was adjudicated into one of four categories as follows: (1) exsanguination, (2) early physiologic collapse, (3) late physiologic collapse, and (4) nonsurvivable injury. RESULTS A total 190 patients underwent massive transfusion or MTP with 76 deaths (40% mortality), of whom 72 deaths were adjudicated to one of four categories: 33.3% died of exsanguination, 16.6% died of early physiologic collapse, 11.1% died of late physiologic collapse, while 38.8% died of nonsurvivable injuries. Patients who died of exsanguination were younger and had the highest RBC/fresh frozen plasma ratio (2.97 [2.24]), although the early physiologic collapse group survived long enough to use the most blood products (p < 0.001). The late physiologic collapse group had significantly fewer penetrating injuries, was older, and had significantly more crystalloid use but received a lower RBC/fresh frozen plasma ratio (1.50 [0.42]). Those who were determined to have a nonsurvivable injury had a lower presenting Glasgow Coma Scale (GCS) score, fewer penetrating injuries, and higher initial blood pressure reflecting a preponderance of nonsurvivable traumatic brain injury. The average survival time for patients with potentially survivable injuries was 2.4 hours versus 18.4 hours for nonsurvivable injuries (p < 0.001). CONCLUSION Severely injured patients requiring MTP have a high mortality rate. However, no studies to date have addressed the cause of death after MTP. Characterization of cause of death will allow targeting of surgical and resuscitative conduct to allow extension of the physiologic reserve time, therefore rendering previously nonsurvivable injury potentially survivable. LEVEL OF EVIDENCE Prognostic study, level III.Journal of Trauma and Acute Care Surgery 08/2013; 75:S255-S262. DOI:10.1097/TA.0b013e31829a24b4 · 1.97 Impact Factor