Changing Epidemiology of Trauma Deaths Leads to a Bimodal Distribution

Abstract

Injury mortality was classically described with a trimodal distribution, with immediate deaths at the scene, early deaths due to hemorrhage, and late deaths from organ failure. We hypothesized that the development of trauma systems has improved prehospital care, early resuscitation, and critical care and altered this pattern. This population-based study of all trauma deaths in an urban county with a mature trauma system reviewed data for 678 patients (median age, 33 years; 81% male; 43% gunshot, 20% motor vehicle crashes). Deaths were classified as immediate (scene), early (in hospital, ≤4 hours from injury), or late (>4 hours after injury). Multinomial regression was used to identify independent predictors of immediate and early versus late deaths, adjusted for age, gender, race, intention, mechanism, toxicology, and cause of death. Results showed 416 (61%) immediate, 199 (29%) early, and 63 (10%) late deaths. Compared with the classical description, the percentage of immediate deaths remained unchanged, and early deaths occurred much earlier (median 52 vs 120 minutes). However, unlike the classic trimodal distribution, the late peak was greatly diminished. Intentional injuries, alcohol intoxication, asphyxia, and injuries to the head and chest were independent predictors of immediate death. Alcohol intoxication and injuries to the chest were predictors of early death, while pelvic fractures and blunt assaults were associated with late deaths. In conclusion, trauma deaths now have a predominantly bimodal distribution. Near elimination of the late peak likely represents advancements in resuscitation and critical care that have reduced organ failure. Further reductions in mortality will likely come from prevention of intentional injuries and injuries associated with alcohol intoxication.

Assessment of Causes of Preventable Deaths in Pre-hospital SettingsAssessment of Causes of Preventable Deaths in Pre-hospital Settings

“…73.3% (22 cases) and 20% (6 cases) were transported by EMS and other vehicles, respectively. This mortality rate was a little more than other studies including Lim's in England (62%), Mac Leod's in the USA (78%), Mark Gunst's in the USA (61%), and Meel's in South Africa (74%) (8,10,12,13). Patients who had transfered by EMS were the main way of achieving to Artesh hospital (62%) and Shohadaye hafome tir hospital (48%) (14,15).…”

“…In all cases, male death was dominant. Traffic accident in England and Hussain et (7,(9)(10)(11)(12). In our study, due to its low rates (2 cases) penetrating trauma was not evaluated.…”

“…According to the results of Stewen's study in the USA, 51% of the mortality rate was because of CNS injury, 21% from hemorrhage, 16% from CNS injury with hemorrhage, and 9% from multi-organ damage (16). In Mark Gunst's study in the USA, 40% and 23% of mortality were caused by CNS injury and multi-organ damage, respectively (12). Mortality of traumatic patients were classified in 3 groups: 1.…”

Blunt Thoracic Injury Mortality and Clinical Presentation

“…The most commonly reported mechanism of injury was car accident (2,999, 40.5%) followed by falls (1,529,20.6%, and motorbike accidents (964, 13.1%). Head, neck and thorax injuries were most common comorbidities in thorax trauma patients.…”

“…Trauma is the leading cause of death in patients under 40 years of age (1) and the fourth leading cause of death globally (2,3). World health organization (WHO) announced in 2004 that trauma was the fourth main cause of death in Iran, and would turn into the third cause of death by 2020 (4).…”