Citation

Efron DT, Haider A, Chang D, Haut ER, Brooke B, Cornwell EE. Arch. Surg. (1960) 2006; 141(8): 800-3; discussion 803-5.

Affiliation

Division of General and Gastrointestinal Surgery, Trauma, and Surgical Critical Care, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.

Copyright

(Copyright © 2006, American Medical Association)

DOI

10.1001/archsurg.141.8.800

PMID

16924088

Abstract

HYPOTHESIS: A growing proportion of urban trauma mortality is characterized by devastating and likely nonsurvivable injuries. DESIGN: Consecutive samples from prospectively collected registry data. SETTING: University level I trauma center. PATIENTS: All trauma patients from January 1, 2000, to March 31, 2005. MAIN OUTCOME MEASURES: Data for trauma patients, including locale of death and mechanism of injury, comparing early (years 2000 through 2003) and late (2004 and 2005) periods. RESULTS: A total of 11 051 trauma visits were registered during the study period with 366 deaths for an overall mortality of 3.3%. Penetrating injury occurred in 26.7% of patients; however, 71.9% of trauma mortalities (263 patients) died with penetrating injuries. Of the patients who died, 48.3% demonstrated severe penetrating injuries (Abbreviated Injury Score >/=4) to the head while 32.7% presented with severe penetrating chest injuries. There was a significant increase in the mortality rate over time (3.0% [early] vs 4.3% [late], P<.01). In parallel, emergency department mortality (patients dead on arrival and those not surviving to hospital admission) increased from 1.7% to 3.1% (P<.005), yet postadmission mortality remained constant (1.3% [early] vs 1.2% [late], P = .77). When emergency department mortality and the subsequent hospital mortality of patients with gunshot wounds to the head were combined, this represented 82.6% of all trauma mortalities in the late period. This was increased from 69.7% during the early period (P<.01). CONCLUSIONS: While in-hospital mortality has remained the same, the proportion of nonsurvivable traumatic injuries has increased. In a mature trauma system, this provides a compelling argument for violence prevention strategies to reduce urban trauma mortality.

Language: en