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01-11-2007

Epidemiology and Contemporary Patterns of Trauma Deaths: Changing Place, Similar Pace, Older Face

Authors: Kjetil Søreide, Andreas J. Krüger, Anne Line Vårdal, Christian Lycke Ellingsen, Eldar Søreide, Hans Morten Lossius

Published in: World Journal of Surgery | Issue 11/2007

Abstract

Background

The epidemiology of trauma deaths in Europe is less than well investigated. Thus, our goal was to study the contemporary patterns of trauma deaths within a defined population with an exceptionally high trauma autopsy rate.

Methods

This was a retrospective evaluation of 260 consecutive trauma autopsies for which we collected demographic, pre-hospital and in-hospital data. Patients were analyzed for injury severity by standard scoring systems (Abbreviated Injury Scale [AIS], Revised Trauma Score [RTS], and Injury Severity Score [ISS]), and the Trauma and Injury Severity Scale [TRISS] methodology.

Results

The fatal trauma incidence was 10.0 per 100,000 inhabitants (17.4 per 100,000 age-adjusted ≥ 55 years). Blunt mechanism (87%), male gender (75%), and pre-hospital deaths (52%) predominated. Median ISS was 38 (range: 4–75). Younger patients (<55 years) who died in the hospital were more often hypotensive (SBP < 90 mmHg; p = 0.001), in respiratory distress (RR < 10/min, or > 29/min; p < 0.0001), and had deranged neurology on admission (Glasgow Coma Score [GCS] ≤ 8; p < 0.0001), compared to those ≥ 55 years. Causes of death were central nervous system (CNS) injuries (67%), exsanguination (25%), and multiorgan failure (8%). The temporal death distribution is model-dependent and can be visualized in unimodal, bimodal, or trimodal patterns. Age increased (r = 0.43) and ISS decreased (r = –0.52) with longer time from injury to death (p < 0.001). Mean age of the trauma patients who died increased by almost a decade during the study period (from mean 41.7 ± 24.2 years to mean 50.5 ± 25.4 years; p = 0.04). The pre-hospital:in-hospital death ratio shifted from 1.5 to 0.75 (p < 0.007).

Conclusions

While pre-hospital and early deaths still predominate, an increasing proportion succumb after arrival in hospital. Focus on injury prevention is imperative, particularly for brain injuries. Although hemorrhage and multiorgan failure deaths have decreased, they do still occur. Redirected attention and focus on the geriatric trauma population is mandated.

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Title: Epidemiology and Contemporary Patterns of Trauma Deaths: Changing Place, Similar Pace, Older Face
Authors: Kjetil Søreide
Andreas J. Krüger
Anne Line Vårdal
Christian Lycke Ellingsen
Eldar Søreide
Hans Morten Lossius
Publication date: 01-11-2007
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 11/2007
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-007-9226-9

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Epidemiology and Contemporary Patterns of Trauma Deaths: Changing Place, Similar Pace, Older Face

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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