Violent death in London: in the news, but not in the database

Webster, Stacey; Lawton, Graham; Barnard, Ed

doi:10.1136/emermed-2020-209468

Cited by 5 publications

(5 citation statements)

References 7 publications

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“…Little is known about trauma patients who die before hospital admission, because these patients are typically not included in clinical registries. As a result, there is a lack of knowledge about the circumstances leading to prehospital trauma death and the interventions performed professionally to save these patients [ 22 , 27 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…As a result, there is a complete lack of information about patients who died prehospital. This information would be important to gain in-depth knowledge about this important group, particularly to improve prehospital trauma care [ 22 – 27 ]. The aim of the present study was to compare patients who died before hospital admission with those who sustained life-threatening injuries in HEMS missions.…”

Section: Introductionmentioning

confidence: 99%

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The forgotten cohort-lessons learned from prehospital trauma death: a retrospective cohort study

Jakob,

Müller,

Jud

et al. 2023

Scand J Trauma Resusc Emerg Med

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Background Trauma related deaths remain a relevant public health problem, in particular in the younger male population. A significant number of these deaths occur prehospitally without transfer to a hospital. These patients, sometimes termed “the forgotten cohort”, are usually not included in clinical registries, resulting in a lack of information about prehospitally trauma deaths. The aim of the present study was to compare patients who died prehospital with those who sustained life-threatening injuries in order to analyze and potentially improve prehospital strategies. Methods This cohort study included all primary operations carried out by Switzerland's largest helicopter emergency medical service (HEMS) between January 1, 2011, and December 31, 2021. We included all adult trauma patients with life-threatening or fatal conditions. The outcome of this study is the vital status of the patient at the end of mission, i.e. fatal or life-threatening. Injury, rescue characteristics, and interventions of the forgotten trauma cohort, defined as patients with a fatal injury (NACA score of VII), were compared with life-threatening injuries (NACA score V and VI). Results Of 110,331 HEMS missions, 5534 primary operations were finally analyzed, including 5191 (93.8%) life-threatening and 343 (6.2%) fatal injuries. More than two-thirds of patients (n = 3772, 68.2%) had a traumatic brain injury without a significant difference between the two groups (p > 0.05). Thoracic trauma (44.6% vs. 28.7%, p < 0.001) and abdominal trauma (22.2% vs. 16.1%, p = 0.004) were more frequent in fatal missions whereas pelvic trauma was similar between the two groups (13.4% vs. 12.9%, p = 0.788). Pneumothorax decompression rate (17.2% vs. 3.7%, p < 0.001) was higher in the forgotten cohort group and measures for bleeding control (15.2% vs. 42.7%, p < 0.001) and pelvic belt application (2.9% vs. 13.1% p < 0.001) were more common in the life-threating injury group. Conclusion Chest decompression rates and measures for early hemorrhage control are areas for potential improvement in prehospital care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The forgotten cohort-lessons learned from prehospital trauma death: a retrospective cohort study

Jakob,

Müller,

Jud

et al. 2023

Scand J Trauma Resusc Emerg Med

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“…[22] We live in an unstable world with increasing numbers of battlefield-type injuries being treated in UK emergency departments, whether that be from terrorist incidents, [23] or due to increasing violence on the streets from knife and gun crime, [24] and so lessons from this study might be applicable to civilian emergency departments. [2] It has also been recognised that in terrorist attacks there is a therapeutic vacuum where casualties may die in the hot zone before sufficient medical care can be given. [25] Therefore, lessons from the battlefield are increasingly applicable to major incident planning and those involved in the trauma care pathway.…”

Section: Discussionmentioning

confidence: 99%

“…Most fatalities from trauma, in civilian and military settings, die before reaching a medical treatment facility (MTF). [1,2] Paradoxically, this is the least researched and understood phase of care. It is accepted that the sooner a patient reaches definitive medical care, the better the outcome from severe trauma.…”

Section: Introductionmentioning

confidence: 99%

Killed in action (KIA): an analysis of military personnel who died of their injuries before reaching a definitive medical treatment facility in Afghanistan (2004–2014)

et al. 2020

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IntroductionThe majority of combat deaths occur before arrival at a medical treatment facility but no previous studies have comprehensively examined this phase of care.MethodsThe UK Joint Theatre Trauma Registry was used to identify all UK military personnel who died in Afghanistan (2004–2014). These data were linked to non-medical tactical and operational records to provide an accurate timeline of events. Cause of death was determined from records taken at postmortem review. The primary objective was to report time between injury and death in those killed in action (KIA); secondary objectives included: reporting mortality at key North Atlantic Treaty Organisation timelines (0, 10, 60, 120 min), comparison of temporal lethality for different anatomical injuries and analysing trends in the case fatality rate (CFR).Results2413 UK personnel were injured in Afghanistan from 2004 to 2014; 448 died, with a CFR of 18.6%. 390 (87.1%) of these died prehospital (n=348 KIA, n=42 killed non-enemy action). Complete data were available for n=303 (87.1%) KIA: median Injury Severity Score 75.0 (IQR 55.5–75.0). The predominant mechanisms were improvised explosive device (n=166, 54.8%) and gunshot wound (n=96, 31.7%).In the KIA cohort, the median time to death was 0.0 (IQR 0.0–21.8) min; 173 (57.1%) died immediately (0 min). At 10, 60 and 120 min post injury, 205 (67.7%), 277 (91.4%) and 300 (99.0%) casualties were dead, respectively. Whole body primary injury had the fastest mortality. Overall prehospital CFR improved throughout the period while in-hospital CFR remained constant.ConclusionOver two-thirds of KIA deaths occurred within 10 min of injury. Improvement in the CFR in Afghanistan was predominantly in the prehospital phase.

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“…Relevant to this is the letter from Webster et al 3 who correctly point out that the national trauma registry for England, Wales and Northern Ireland—the Trauma Audit and Research Network (TARN)—has not captured the majority of people who died in London in 2019 from penetrating trauma, whereas the deaths were reported in the media. In common with the majority of international trauma registries, TARN functions and is funded primarily as a hospital quality improvement, assurance and research body, with ‘Time Zero’ being when the patient arrives in the first emergency department.…”

mentioning

confidence: 99%