Is the trimodal pattern of death after trauma a dated concept in the 21st century? Trauma deaths in Auckland 2004

Pang, Jia-Min; Civil, Ian; Ng, Alexander K.; Adams, David P.; Koelmeyer, Timothy D.

doi:10.1016/j.injury.2007.05.022

Cited by 64 publications

(65 citation statements)

References 7 publications

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“…The premiership of CNS injury as the leading cause of trauma death is a consistent feature of published reports that does not seem to depend on locale, although the exact proportion varies by centre. Comparable data from Norway and The Netherlands document rates of 67% and 51%, respectively,19 20 and 71.5% in New Zealand 21. In North American centres, the corresponding figure is generally lower and ranges from 32% to 55%,13 14 16 18 although these studies are markedly heterogeneous in their setting, methodology and definitions.…”

Section: Discussionmentioning

confidence: 98%

“…Using this method, there did not appear to be any difference in temporal distribution between penetrating and blunt fatalities. Other authors have suggested that the failure of their own studies to describe a third hump of late deaths reflects improvements in trauma systems and critical care capability,14 16 21 a higher prevalence in penetrating trauma15 17 18 or a combination of factors 20. However, one of the first papers to question the trimodal doctrine originates from a study of trauma death between 1992 and 1994 conducted in the Lothian and Borders region of Scotland—an area low in penetrating mortality and with no systemisation of trauma care.…”

Section: Discussionmentioning

confidence: 99%

“…Although such cumulative epidemiological data are useful, specific descriptions of trauma mortality in patients admitted to individual UK trauma centres are few and not reflective of contemporary practice 11 12. Furthermore, while current information on the cause, time and place of death for trauma patients treated in British hospitals is poorly described, better descriptions from large North American,13–18 European19 20 and Australasian21 centres reflect local situations and, thus, may differ substantially from domestic circumstances.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Deaths from trauma in London--a single centre experience

Chalkley

Cheung

Walsh

et al. 2010

Emergency Medicine Journal

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Deaths from trauma in London--a single centre experience

Chalkley

Cheung

Walsh

et al. 2010

Emergency Medicine Journal

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“…1–3 Eiseman et al coined the term “multiple organ failure” (MOF) in 1977, with a clinical description of 42 patients with progressive organ dysfunction. 4 By the 1990s, Moore et al proposed that MOF was a bimodal phenomenon.…”

Section: Historical Perspective: Evolving Concepts On the Pathogenesimentioning

confidence: 99%

Postinjury Inflammation and Organ Dysfunction

Sauaia

Moore

2017

Critical Care Clinics

145

106

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Synopsis The development of organ dysfunction (OD) is related to the intensity and balance between trauma-induced simultaneous, opposite inflammatory responses. Early proinflammation via innate immune system activation may cause early OD, while anti-inflammation, via inhibition of the adaptive immune system and apoptosis, may induce immunoparalysis, impaired healing, infections, and late OD. Patients discharged with low level OD may develop the persistent inflammation-immunosuppression catabolism syndrome (PICS). Although the incidence of multiple organ failure (MOF) has decreased over time, it remains morbid, lethal and resource-intensive. Single OD, especially acute lung injury, however, remains frequent. At this time, treatment is limited, and prevention remains the mainstay strategy.

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“…The organization of the modern trauma systems is based on the trimodal distribution of mortality, proposed by Donald Trunkey in 1983 [2] . This concept is very useful for educational purposes, but inconsistent with the more recent evidence [3][4][5] . According to this trimodal pattern, there are three peaks of mortality secondary to trauma.…”

Section: Introductionmentioning

confidence: 94%

Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution

Negoi

Păun

Hostiuc

et al. 2015

Journal of Acute Disease

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Objective: To characterize the pattern of mortality for major trauma patients. Methods: Retrospective study of major trauma patients admitted in a Level I trauma center, during the latest 5 years was conducted. Selection criteria included (1) injury severity score (ISS) > 16 and (2) in-hospital death. Results: There were 47 patients, with a mean age of 37.2 ± 19.9 years. The mean ISS was 37.6 ± 12.7 and the mean revised trauma score was 4.5 ± 2.2. Computed tomography scan on admission was done in 18 (38%) patients, 20% being hemodynamically unstable (P = 0.001). The diagnostic peritoneal lavage was performed in 10 (22%) cases, 23.3% being hemodynamically unstable (P > 0.05). The mean number of intraabdominal injuries was 3. The need for transfusion was 8.2 ± 6.7 units. The mean time to death was 4.9 days. Early death was secondary to hemorrhagic shock (HS) (ISS = 35.2 ± 15.9, P > 0.05, revised trauma score = 3.74 ± 2.70, P = 0.008) and multiple organ failure (ISS = 36.6 ± 14.1, P > 0.05, revised trauma score = 5.94 ± 1.34, P = 0.008) was the cause for later mortality. Combined liver and splenic injuries were found in 13 cases, with secondary death through HS in 5 and multiple system organ failure (MSOF) in 8 cases. Combined liver, splenic and kidney injuries were found in 5 cases (cause of death: HS 2 cases, MSOF 3 cases). A total of 14 patients had associated head, thorax, abdomen and extremity trauma (cause of death: cerebral trauma 6 cases, MSOF 5 cases, HS 2 cases); 5 patients had thorax and abdomen trauma (cause of death: HS 5 cases); 8 patients had thorax, abdomen and extremity trauma (cause of death: MSOF 5 cases, HS 3 cases); 3 patients had abdomen and extremity trauma (HS 2 cases). We did not find a trimodal time distribution for mortality. Conclusions: The trimodal time distribution of mortality remains a milestone in trauma education and research. Nevertheless, it must be questioned in the modern and very efficient trauma systems, but still very actual for developing trauma care systems. In conclusion, the pattern of mortality due to major trauma seems decreasing continuously with time rather than presenting high peaks of frequency at some moments.

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Is the trimodal pattern of death after trauma a dated concept in the 21st century? Trauma deaths in Auckland 2004

Cited by 64 publications

References 7 publications

Deaths from trauma in London--a single centre experience

Deaths from trauma in London--a single centre experience

Postinjury Inflammation and Organ Dysfunction

Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution

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