Trauma fatalities: Time and location of hospital deaths

BACKGROUND: Analysis of the epidemiology, temporal distribution, and place of traumatic hospital deaths can be a useful tool in identifying areas for research, education, and allocation of resources. STUDY DESIGN: Trauma registry-based study of all traumatic hospital deaths at a Level I urban trauma center during the period 1993 to 2002. The time and hospital location where deaths occurred were analyzed according to mechanism of injury, age, Glasgow Coma Score, and body areas with severe injury (Abbreviated Injury Scale [AIS] greater than or equal to 4). Logistic regression analysis was used to identify risk factors associated with death at various times after admission. RESULTS: During the study period there were 2,648 hospital trauma deaths. The most common body area with critical injuries (AIS greater than or equal to 4) was the head (43%), followed by the chest (28%) and the abdomen (19%). Overall, 37% of victims had no vital signs present on admission. Chest AIS greater than or equal to 4, penetrating trauma, and age greater than 60 years were significant risk factors associated with no vital signs on admission. Patients with severe chest trauma (AIS greater than or equal to 4) reaching the hospital alive were significantly more likely to die within the first 60 minutes than were patients with severe abdominal or head injuries (17% versus 11% versus 7%). In patients reaching the hospital alive, the time and place of death varied according to mechanism of injury and injured body area. Deaths caused by severe head trauma peaked at 6 to 24 hours, and deaths caused by severe chest or abdominal trauma peaked at 1 to 6 hours after admission. CONCLUSIONS: The temporal distribution and location of trauma deaths are influenced by the mechanism of injury, age, and the injured body area. These findings may help in focusing research, education, and resource allocation in a more targeted manner to reduce trauma deaths. (C) 2004 by the American College of Surgeons.