The Contemporary Timing of Trauma Deaths

Background The distribution of trauma deaths was classically described as trimodal. With advances in both technology and trauma systems, this was re-evaluated and found to be bimodal in the early 2000s. Over the last decade there have been continued improvements in trauma and ICU care, related to damage control techniques and evidence based ICU pathways. A better understanding of the distribution of trauma deaths may be used to improve trauma systems. This study aimed to evaluate the contemporary distribution of trauma deaths after the widespread implementation of modern trauma and critical care principles. Methods This study included patients entered in the NTDB® from 2008-2014. For expired patients, hospital length of stay was equated to time until death. Additional data was collected to include demographics, mechanism of injury, ISS, and AIS scores. Histograms were plotted to demonstrate peaks in deaths. Survival analysis was performed with Kaplan-Meier curves and Gehan-Breslow generalized Wilcoxon tests. Results 4,185,009 patients were analyzed. 34% of all deaths occurred within the first 24 hours of admission. The factors most associated with death in the first 24 hours were severe abdominal trauma (73%), penetrating trauma (55%), and severe extremity trauma (58%). Among patients with penetrating trauma and an abdominal AIS≥4, 83% of deaths occurred within 24 hours. When plotted, the distribution of deaths was seen to fall rapidly after the first 24 hours and continued to be flat for 30 days in all subgroups analyzed. Conclusions In this study, the distribution of trauma deaths no longer appears to be trimodal. This may reflect advances in trauma and ICU care, and the widespread adoption of damage control principles. Early deaths, however, remains a significant challenge, specifically from non-compressible abdominal hemorrhage and extremity trauma. Primary prevention and early hemorrhage control must continue to be a focus of research and trauma systems. Level of Evidence IV Study Type Epidemiologic Corresponding Author: Kenji Inaba, MD, FRCSC, FACS, Los Angeles County + University of Southern California Medical Center, Division of Trauma and Acute Care Surgery, 2051 Marengo Street, IPT C5L100, Los Angeles, CA 90033. Email: Kenji.Inaba@med.usc.edu The authors have no financial disclosures or conflicts of interest to report. No funding was received for this work. The data in this manuscript is the original work of the authors. It will be presented as a Quick Shot at the 2017 Annual Meeting of the AAST. © 2018 Lippincott Williams & Wilkins, Inc.

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