Timing and Causes of Death After Injuries

Abstract

Currently, long-term outcomes are significant because health care system changes will likely lead to a single payment for each occurrence of care, including readmissions-the "bundled payment" system. Therefore, it is essential to understand the outcomes of trauma patients discharged alive from trauma centers. This article reviews the current knowledge base on the timing and causes of deaths after trauma. The trimodal mortality model (immediate deaths, early deaths, and late deaths) is utilized as the early research describing trimodal distribution is discussed. Also covered is the successive work as trauma systems matured, showing a shift toward a bimodal distribution with a decline in late deaths. Finally, studies of long-term outcomes are highlighted. Deaths occurring within minutes or a few hours of injury are largely unchanged, which underscores the enormity of injuries to the central nervous and cardiovascular systems. Late deaths caused by multiple organ failure and sepsis have declined considerably, however. Also, the causes of death in this patient population remain constant. Lastly, a considerable number of deaths after discharge may be due to nontraumatic causes.

Logistic Regression Modeling for Evaluation of Factors Affecting Trauma Outcome in a Level I Trauma Center in Shiraz

“…The cut point regarding the definition of early/late in-hospital death varies across different studies (14). Herein, we stratified deaths into those occurring within 48 hours of admission (early) and those occurring beyond this period (late), since we were interested in examining the contribution of HAIs to in-hospital mortality.…”

“…It was the most important risk factor for late death, and we estimate the true effect to be far greater, since we could not include all of the patients with HAI in this study. Multiple previously published studies have declared sepsis and multiple organ failure to be the most important cause of late in-hospital deaths (14). In addition, HAI is considered to be associated with increased LOS and financial costs (40).…”

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

“…Independent predictors of mortality were age over 55 years, ISS 16, major cerebral trauma, cardiopulmonary resuscitation on arrival and a probability of survival according to trauma and injury severity score less than 25% [24] . An evaluation of the trauma mortality supports that traumatic brain injuries and hemorrhage, as causes of deaths, remain constant over time, while late mortality secondary to MSOF and sepsis significantly decreased [25] .…”

Topical hemostatics for bleeding control in pre-hospital setting: Then and now

“…Hemorrhage is the second leading cause of death after traumatic brain injury in immediate and early phases of trauma. [3] With increasing occurrence of terrorist attacks globally, it will not be surprising to experience a constant rise in exsanguination incidence among civilian mass casualties.…”