Authors: Julie A Evans Karlijn J P van Wessem Debra McDougall Kevin A Lee Timothy Lyons Zsolt J Balogh
Publish Date: 2009/10/31
Volume: 34, Issue: 1, Pages: 158-
Abstract
The epidemiology of traumatic deaths was periodically described during the development of the American trauma system between 1977 and 1995 Recognizing the impact of aging populations and the potential changes in injury mechanisms the purpose of this work was to provide a comprehensive prospective populationbased study of Australian traumarelated deaths and compare the results with those of landmark studiesAll prehospitalization and inhospital trauma deaths occurring in an inclusive trauma system at a single Level 1 trauma center 400 patients with an injury severity score ISS 15/year underwent autopsy and were prospectively evaluated during 2005 Highenergy HE and lowenergy LE deaths were categorized based on the mechanism of the injury time frame prehospitalization 48 hours 2–7 days 7 days and cause which was determined by an expert panel and included central nervous systemrelated CNS exsanguination CNS + exsanguination airway multiple organ failure MOF Data are presented as a percent or the mean ± SEMThere were 175 deaths during the 12month period For the 103 HE fatalities age 43 ± 2 years ISS 49 ± 2 male 63 the predominant mechanisms were motor vehicle related 72 falls 4 gunshots 8 stabs 6 and burns 5 In all 66 of the patients died during the prehospital phase 27 died after 48 hours in hospital 5 died after 3 to 7 days in hospital and 2 died after 7 days CNS 33 and exsanguination 33 were the most common causes of deaths followed by CNS + exsanguination 17 and airway compromise 8 MOF occurred in only 3 Six percent of the deaths were undetermined All LE deaths n = 72 age 83 ± 1 years ISS 14 ± 1 male 45 were due to low falls All LE patients died in hospital 20 48 hours 32 after 3–7 days 48 after 7 days The causes of deaths were head injury 26 and complications of skeletal injuries 74The HE injury mechanisms time frames and causes in our study are different from those in the earlier seminal reports The classic trimodal death distribution is much more skewed to early death Exsanguination became as frequent as lethal head injuries but the incidence of fatal MOF is lower than reported earlier LE trauma is responsible for 41 of the postinjury mortality with distinct epidemiology The LE group deserves more attention and further investigation
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