Time and Place of Death from Automobile Crashes: Research Endpoint Implications.

Background: Vehicle crashes are a leading cause of US injury and death. Early death, however, has almost entirely been studied in-hospital. The US Department of Transportation Fatality Analysis Reporting System (FARS) database captures both prehospital and in-hospital mortality. Methods: FARS location (prehospital, in-hospital) and time of death were reviewed (1978-2013) and a 2003-2005 subgroup of 55,537 early deaths (i.e., between 5 minutes and 4 hours post-injury) was analyzed to quantify risk of death over time. Results: There has been an overall decrease in 1978-2013 US vehicle-related deaths (from 3.3 deaths per 100 million vehicle miles [VMT] travelled to 1.1, and from 22.6 per 100,000 population to 10.4). Snapshots of the death data reveal an overall downward trend of total in-hospital and prehospital deaths. The proportion of hospital deaths decreased by 58% whereas the proportion of deaths in the prehospital period increased to 56%. Subgroup analysis revealed a rate of mortality risk of 0.4%/minute for the first 30 minutes, 1%/minute for the next 60 minutes and 0.2%/minute and plateauing thereafter. Conclusions: Analysis of census FARS data of motor vehicle crash-related deaths showed an overall 35% decrease in mortality over a period of 36 years. The disproportionate reduction in in-hospital deaths is perhaps a testament to the effectiveness of trauma centers. However, there is a demonstrable need to focus on prehospital deaths with resuscitative and adjuvant therapy research and trauma system design. Quantifying risk of death over time should help focus EMS, trauma system, and resuscitation goals. Level of Evidence: 3 Study Type: Economic and value-based evaluation (C) 2016 Lippincott Williams & Wilkins, Inc.

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