Original Scientific Articles
Lethal Injuries and Time to Death in a Level I Trauma Center 1

https://doi.org/10.1016/S1072-7515(98)00082-9Get rights and content

Abstract

Background: The purpose of this study was to identify the causes and time to death of all trauma victims who died at a level I trauma center during an 11-year period.

Study Design: Autopsies were performed on all patients who died secondary to trauma. Retrospective review of these autopsies was carried out and appended to existing trauma registry data. Standard definitions were used to attribute the cause of death in each case. Preventable deaths were determined by a standardized peer review process.

Results: Between January 1985 and December 1995, a total of 900 trauma patients died. This represented 7.3% of all major trauma admissions (12,320). Seventy percent of these patients died within the first 24 hours of admission. Thoracic vascular and central nervous system (CNS) injuries were the most common causes of death in the first hour after admission to the hospital. CNS injuries were the most common causes of death within the 72 deaths after admission. Acute inflammatory processes (multiple organ failure, acute respiratory distress syndrome, and pneumonia) and pulmonary emboli were the leading causes of death after the first 72 hours. Overall, 43.6% (393 of 900) of all trauma deaths were caused by CNS injuries, making this the most common cause of death in our study. The preventable death rate was 1%.

Conclusions: The first 24 hours after trauma are the deadliest for these patients. Primary and secondary CNS injuries are the leading causes of death. Prevention, early identification, and treatment of potentially lethal injuries should remain the focus of those who treat trauma patients.

Section snippets

Methods

A retrospective autopsy review was performed on all trauma deaths at The University of California San Diego (UCSD) Medical Center from January 1985 to December 1995. Patients were included in this study if they met criteria for transport to a level I trauma center. All patients who died as a consequence of traumatic injuries underwent autopsy by the Coroner’s Office. Information collected included demographic data, mechanism of trauma, description of all anatomic injuries, and cause of death as

Results

During the study period 12,320 trauma patients were admitted to The UCSD Medical Center Trauma Service, 900 (7.3%) of whom died. Mortality for victims of penetrating trauma was 11% (363 of 3,125) and of blunt mechanism was 5.8% (537 of 9,195) (p < 0.0001). The average age for all patients who died was 36.5 ± 19.5 years. The average age for patients dying from blunt trauma was 40.2 ± 21 years and for penetrating trauma was 31 ± 15.3 years (p < 0.001). The male to female ratio was 8.55:1 in the

Discussion

Review of the causes of trauma deaths has been suggested as necessary for the evaluation of care and for future planning of trauma centers.[1]This group of patients needs close scrutiny because it has been shown that the clinical impression of the cause of death is incorrect in up to 30% of cases.[1]The present study reviews the autopsies of patients who died at a level I trauma center during an 11-year period, focusing on causes and time to death. Although other retrospective studies of trauma

References (34)

  • RB Presswalla et al.

    Medico-legal autopsies. A study of 1380 consecutive cases in a period of 30 months. ITraumatic and burns cases

    J Postgrad Med

    (1968)
  • WU Spitz

    Essential postmortem findings in the traffic accident victim

    Arch Pathol

    (1970)
  • JI Tonge et al.

    Traffic crash fatalitiesinjury patterns and other factors

    Med J Aust

    (1972)
  • DW Hossack

    The pattern of injuries received by 500 drivers and passengers killed in road accidents

    Med J Aust

    (1972)
  • JC Stothert et al.

    The role of autopsy in death resulting from trauma

    J Trauma

    (1990)
  • HPR Smith

    Time to die from injuries received in road traffic accidents

    Injury

    (1970)
  • HD Reines et al.

    Survivability of victims of traumatic injuries in eastern South Carolina

    Am Surg

    (1983)
  • Cited by (499)

    • Resuscitation and Care in the Trauma Bay

      2024, Surgical Clinics of North America
    View all citing articles on Scopus
    1

    The views expressed in this article are those of the author(s) and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the U.S. Government.

    View full text