Sammanfattning
BACKGROUND:
Securing high-quality mortality statistics requires systematic evaluation of all trauma deaths. We
examined the proportion of trauma patients dying within 30 days from causes not related to the injury
and the impact of exclusion of patients dead on arrival on 30-day trauma mortality. We also defined
the demographics, injury characteristics, cause of death and time to death in patients admitted to our
trauma center who died within 30 days, between 2007-2011.
METHODS:
Demographics, injury characteristics, status alive/dead on arrival, cause of death and time to death
of all patients were reviewed. Deaths were analyzed based on injury mechanism (penetrating, blunt
trauma and low energy blunt trauma) and cause of death (traumatic brain injury (TBI), hemorrhage,
organ dysfunction and other/unknown).
RESULTS:
Of the 7422 admissions, 343 deaths were identified of which 36 (10.5%) involved causes not related
to the injury. The overall age was 71 years, Injury Severity Score (ISS) 29 and time to death 24 hours
(all medians). Fifty-four patients (17.6%) were dead on arrival. Exclusion of patients dead on arrival
reduced the overall mortality rate (P < 0.05) and median ISS (P < 0.05) and increased median age (P <
0.01) and time to death (P < 0.001). Injury mechanism was penetrating trauma in 7.5%, blunt trauma in
56.0%, and low energy blunt trauma in 36.5%. TBI accounted for 58.6%; hemorrhage 16.3%, organ
dysfunction 15.0%, and other/unknown for 10.1% of the deaths. Patients who died after low energy
blunt trauma were older, had lower ISS and longer time to death compared to those who died after
penetrating and blunt trauma (all P < 0.01).
CONCLUSIONS:
Clinical review of all trauma deaths was essential to interpret mortality. Thirty-day trauma mortality
included 10.5% deaths not directly related to the injury and the exclusion of patients dead on arrival
significantly affected the unadjusted mortality rate, ISS, median age and time to death.