Predictors of Death in Trauma Patients who are Alive on Arrival at Hospital (original) (raw)
Related papers
Hemorrhage is More Prevalent than Brain Injury in Early Trauma Deaths: The Golden Six Hours
European Journal of Trauma and Emergency Surgery, 2009
Introduction: Under the trimodal distribution, most trauma deaths occur within the first hour. Determination of cause of death without autopsy review is inaccurate. The goal of this study is to determine cause of death, in hourly intervals, in trauma patients who died in the first 24 h, as determined by autopsy. Materials and Methods: Trauma deaths that occurred within 24 h at a Level I trauma center were reviewed over a six-year period ending December 2005. Timing of death was separated into 0–1, 1–3, 3–6, 6–12 and 12–24 h intervals. Cause of death was determined by clinical course and AIS scores, and was confirmed by autopsy results. Results: Overall, 9,388 trauma patients were admitted, of which 185 deaths occurred within 24 h, with 167 available autopsies. Blunt and penetrating were the injury mechanisms in 122 (73%) and 45 (27%) patients, respectively. Of 167 deaths, 73 (43.7%) occurred within the first hour. Brain injury, when compared to other body areas, was the most likely cause of death in all hourly intervals, but hemorrhage was as or more important than brain injury as the cause of death during the first 3 h and up to 6 h. No deaths were attributable to hemorrhage after 12 h. Conclusions: The temporal distribution of the cause of death varies in the first 24 h after admission. Hemorrhage should not be overlooked as the cause of death, even after survival beyond 1 h. Understanding the temporal relationship of causes of early death can aid in the targeting of management and surgical training to optimize patient outcome.
Types and Causalities in Dead Patients Due to Traumatic Injuries
Archives of Trauma Research, 2015
Background: Trauma constitutes a major public health problem in our country and contributes significantly to unacceptably high morbidity and mortality. Objectives: This study aimed to evaluate the epidemiology of trauma in dead patients referred to Shahid Rajaee Trauma Hospital, Shiraz, Iran.
Epidemiology of in-hospital trauma deaths
European Journal of Trauma and Emergency Surgery, 2011
Purpose About half of all trauma-related deaths occur after hospital admission. The present study tries to characterize trauma deaths according to the time of death, and, thereby, contributes to the discussion about factors considered as the cause of death. Methods Data from two large European trauma registries (Trauma Registry of the German Society of Trauma Surgery, TR-DGU, and the Trauma Audit and Research Network, TARN) were analyzed in parallel. All hospital deaths with Injury Severity Score (ISS) [ 9 documented between 2000 and 2010 were considered. Patients were categorized into five subgroups according to the time to death (0-6 h; 7-24 h; day 1-6; day 7-30; beyond day 30). Surviving patients from the same time period served as a control group. Results In total, 6,685 and 6,867 non-survivors were included from the TR-DGU and TARN, respectively. The hospital mortality rate was between 15 and 17%. About half of all deaths occurred within the first 24 h after admission (TR-DGU: 54%; TARN: 45%). The earliest subgroup of trauma deaths showed the highest mean ISS and the highest rate of mass transfusions. Severe head injury was most frequently observed in the subgroup of day 1-6. Late deaths are associated with higher age and more complications (sepsis, multiple organ failure). Conclusions The time to death after severe trauma does not follow a trimodal distribution but shows a constantly decreasing incidence.
European Journal of Trauma and Emergency Surgery, 2013
Objective The classical trimodal distribution of trauma deaths describes three peaks of deaths following trauma: immediate, early and late deaths. The aim of this study was to evaluate whether further maturation of the trauma centre and the improvement of survival have had an effect on the time of death distribution and resulted in a shift in causes of death. Methods All trauma patients from 1999 to 2010 who died after arrival in the emergency room and prior to discharge from the hospital were included. Deaths caused by drowning, poisoning and overdose were excluded. Results A total of 16,421 trauma patients were admitted to our hospital. 772 (4.7 %) patients died, of which 720 were included in this study. The trauma mechanism was predominantly blunt (94.7 %). 530 patients (73.6 %) had Injury Severity Score (ISS) C25. The most frequent causes of death were central nervous system (CNS) injury (59.9 %), exsanguinations (12.9 %) and pneumonia/respiratory insufficiency (8.5 %). The first peak of death was seen in the first hour after arrival at the emergency department; subsequently, a rapid decline was observed and no further peaks were seen. Over the years, we observed a general decrease in deaths due to exsanguination (p = 0.035) and a general increase in deaths due to CNS injury (p = 0.004). Conclusion The temporal distribution of trauma deaths in our hospital changed as maturation of the trauma centre occurred. There is one peak of trauma deaths in the first hour after admission, followed by a rapid decline; no trimodal distribution was observed. Over time, there was a decrease in exsanguinations and an increase of deaths due to CNS injury.
The Medical journal of Malaysia, 2013
Trauma is an ever increasing problem and it is the leading cause of morbidity and mortality in the under 40s age group. The main purpose of this study is to determine the pattern of death related to trauma cases presenting to the emergency department (ED) of a university hospital. This was a retrospective analysis of 75 consecutive trauma case records at a university hospital for a one year period. The most common cause of deaths is motor vehicle crashes. The mean score for the injury severity score (ISS) and revised trauma score (RTS) on arrival to the ED among the succumbed patients were 27.8 (s.d 8.6) and 5.7 (s.d 1.1) respectively. 58.7% of deaths occurred within 48 hours after the admission. Less than 50% of studied patients were still alive beyond 45 hours post admission and less than 10% still alive beyond 11 days. Our analysis also showed that 28% (n=21) and 56% (n=41) of the studied sample had a probability of survival between 50% to 75% and more than 75% respectively upon ...
The Management of Injuries –A Review of Deaths in Hospital
ANZ Journal of Surgery, 1988
A prospective review was undertaken of the management of 1 I I consecutive patients who died in hospital after admission for treatment of injuries. A standard set of data relating to each patient was reviewed by each member of a trauma death audit committee and then by the whole committee. Autopsy reports were available on all patients. Conclusions were drawn concerning defective aspects of patient management and possible avoidance of each death. Injury severity was assessed using the Trauma Score (TS) and Injury Severity Score (ISS). The possibly avoidable death (PAD) rate was 17%. The most common defects in management were related to inadequate fluid resuscitation and delays in definitive management. The greatest contributions to the PAD rate were from inadequate fluid resuscitation. delays and inadequate perception of the severity of injuries or significance of clinical deterioration. Increasing age was related to a higher frequency of PAD. PAD rate in the presence of severe head injury was 8%, hut was 63"/0 in the absence of a severe head injury. It is concluded that review of all trauma deaths is an achievable. beneficial and essential part of a hospital-based integrated trauma service. TS and ISS are not sufficiently sensitive to justify their use in selecting deaths for review. Improved blood volume replacement, earlier and more direct management and supervision by senior specialist staff. and elimination of causes of delay in patient management should all decrease the death rate from injuries particularly in patients without severe head injury.
Journal of Korean Neurotraumatology Society, 2008
Objective: The mortality rate of patients with isolated head injuries is about 20-30%, whereas in multiple traumas with head injuries mortality rates can reach over 40%. The authors reviewed the multiple trauma patients with traumatic brain injury who died in emergency department and wanted to describe causes of deaths and to reconsider the role of neurosurgeons in association with trauma team. Methods: Between July 1999 and May 2007, 48 patients who had multiple traumas were dead in the emergency department of our hospital before admission. Of them, 42 patients were selected in this study. Twenty eight were male and 14 were female. The medical and radiological records were reviewed retrospectively. Results: The mode of accidents consisted of 18 pedestrian traffic accidents (TAs), 10 falls, 5 in car TAs, 4 motorcycle accidents, and 5 others. Initial mentality showed that alert or drowsy were 20 (47.6%), stupor 6 (14.3%), and semicoma or coma 16 (38.1%). Most frequent cause of deaths was hypovolemic shock and followed by hypoxia, severe brain swelling, and tension pneumothorax. The major causes of hypovolemia were pelvic bone fracture and abdominal bleeding. Among them, brain computed tomography (CT) and abdomen CT could be checked in 43% of patients and peripheral angiography in only 5 patients (12%). Conclusion: The major cause of deaths of patients who had traumatic brain injury with multiple traumas in emergency department was not brain injury but hypovolemic shock. Early detection and adequate management of bleeding causes might decrease the mortality.
Patterns of trauma deaths in an accident and emergency unit
Prehospital and disaster medicine
Trauma is a leading cause of death in most countries. Different patterns of trauma deaths are recorded in different countries. The purpose of this study was to evaluate retrospectively the pattern of trauma deaths in the emergency unit of a University Teaching Hospital in Nigeria. This is a descriptive, retrospective study. The data were obtained from patient case files and nurses' records. The data abstracted included age, sex, cause of trauma/death, parts of the body injured, time of death, and the duration of stay in the Accident and Emergency Unit (AEU). A total of 5,537 cases presented to the AEU of the University of Benin Teaching Hospital between 01 January 2001 and 31 December 2004. Of these, 5,446 were due to trauma (98.4%). A total of 127 patients died (case fatality rate: 2.3%). Of the deaths, 81.9% were males. Motor vehicle crashes were the most frequent cause (54.3%), and drowning was the least common cause of trauma (0.8%). The most frequently injured region of the...
Risk factors for death of trauma patients admitted to an Intensive Care Unit
Revista Latino-Americana de Enfermagem, 2020
Objective: To analyze the risk factors for death of trauma patients admitted to the intensive care unit (ICU). Method: Retrospective cohort study with data from medical records of adults hospitalized for trauma in a general intensive care unit. We included patients 18 years of age and older and admitted for injuries. The variables were grouped into levels in a hierarchical manner. The distal level included sociodemographic variables, hospitalization, cause of trauma and comorbidities; the intermediate, the characteristics of trauma and prehospital care; the proximal, the variables of prognostic indices, intensive admission, procedures and complications. Multiple logistic regression analysis was performed. Results: The risk factors associated with death at the distal level were age 60 years or older and comorbidities; at intermediate level, severity of trauma and proximal level, severe circulatory complications, vasoactive drug use, mechanical ventilation, renal dysfunction, failure ...
Characterizing Early Inpatient Death After Trauma
Journal of Surgical Research, 2020
Background: There is a paucity of data to predict early death or futility after trauma. The objective of this study was to characterize the laboratory values, blood product administration, and hospital disposition for patients with trauma who died within 72 h of admission. Methods: All deaths within 72 h of admission over a 5-y period at a level I trauma center were reviewed. Blood transfusion within the first 4 h of arrival and patient disposition from the emergency department to the operating room (OR), surgical intensive care unit, or the neuroscience intensive care unit (NSICU) were analyzed. Kaplan-Meier curves were generated to determine time to death. Results: A total of 622 subjects were identified; 39.5% died in the emergency department, 10.6% went directly to the OR, 13.6% were admitted to the surgical intensive care unit, and 29.7% admitted to the NSICU. Of these subjects, 201 (32.2%) patients received blood within the first 4 h. By 24 h, early blood transfusion was associated with more rapid death for patients who were admitted to the NSICU (80% versus 60% mortality, P ¼ 0.01) but not for patients taken directly to the OR (80% versus 70% mortality, P ¼ 0.2). Admission coagulopathy by international normalized ratio (P < 0.01), but not anemia (P ¼ 0.64) or acidosis (P ¼ 0.45), correlated with a shorter time to death. In contrast, laboratory values obtained at 4 h after admission did not correlate with time to death. Conclusions: Our data demonstrate that admission coagulation derangement and need for early blood product transfusion are the two factors most associated with early death after injury, particularly in those patients with traumatic brain injury. These data will help construct future models for futility of continued care in patients with trauma.