Clinical surgery–AmericanTrauma deaths in the first hour: are they all unsalvageable injuries?
Section snippets
Study design, setting, and inclusion criteria
After receiving Institutional Review Board approval, we reviewed our trauma registry for all deaths that occurred within the first hour after admission at Ryder Trauma Center during the 5-year period from January 1, 1995, to February 28, 2000. Ryder Trauma Center is part of a statewide trauma system and was already well developed by 1995, including helicopter services from 1986. Only Advanced Life Support–trained EMS paramedics and flight crew flew the helicopters and drove the ambulances for
Characteristics of the study cohort
There were 556 deaths during the study period, and 65 of these patients did not have a full autopsy report for data retrieval. In Fig. 1, the analysis of the 556 study patients by completeness of data and presence or absence of vital signs is shown.
Mean age was 39 years, and there were 49% white, 39% black, and 12% Hispanic patients. Men accounted for 78% of the population, and the mean length of resuscitation efforts from the time of hospital admission was 10.3 minutes (SD [mean] = .5
Limitations
Because our study was retrospective in design it has a number of inherent weaknesses. First, any investigation of time to death is biased by the health personnel’s intrinsic definition of declaration of death. For example, patients with similar injuries or conditions at time of arrival at the trauma center may or may not be pronounced dead at the same time or in the same fashion by different health care providers. Second, the autopsy information is retrieved by a medically trained health care
Comments
Early death is caused by a broad spectrum of injuries, with head injury being the main cause of early death for patients with and without vital signs at the scene. Vessel disruption was also a major cause for both groups of patients. Previously published literature on the epidemiology of trauma death also reported head injury, followed by vascular injury, as the main causes of death [1], [8], [9], [12], [13], [14], [15].
Many investigators have shown that most deaths occur within the first 24
References (25)
- et al.
Epidemiology of major trauma and trauma deaths in Los Angeles County
J Am Coll Surg
(1998) - et al.
An autopsy study of traumatic deaths: San Diego County—1979
Am J Surg
(1982) - et al.
Lethal injuries and time to death in a level I trauma center
J Am Coll Surg
(1998) - et al.
Looking at trauma and deaths: Diyarbakir city in Turkey
Injury
(1999) - et al.
Analysis of 425 consecutive trauma fatalities: an autopsy study
J Am Coll Emerg Phys
(1974) - et al.
Epidemiology of trauma deaths
Am J Surg
(1980) Fatal road accidents in Birmingham: times to deaths and their causes
Injury
(1973)Trauma mortality in Orange County: the effect of implementation of a regional trauma system
Ann Emerg Med
(1984)- et al.
The epidemiology of traumatic deathA population-based analysis
Arch Surg
(1993) - et al.
Epidemiology of violent deaths in the world
Inj Prev
(2001)
Trauma
Sci Am
The time of death after trauma
Br Med J
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2021, American Journal of SurgeryCitation Excerpt :The success of the resuscitative team relies on clear communication and effective leadership.2 Non-technical errors during the initial resuscitation are responsible for up to one third of preventable errors leading to in-hospital, trauma-related death.3 Team-based training of trauma teams to improve non-technical and communication skills is essential to improving overall trauma outcomes4,5 and many metrics of trauma patient care, including reduction of time to critical operation6 or intervention.7
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2019, Journal of Transport and HealthCitation Excerpt :Mainstream opinions (e.g. Gonzalez et al., 2009; Wilde, 2013) acknowledge the considerable influence the EMS response time has on death likelihood, in that an increased EMS response time will lead to an elevated risk of fatality for general emergent events (Bunn et al., 2012; Heestermans et al., 2010; Saver et al., 2010) and traffic crashes (Delmelle et al., 2005; Li et al., 2008; Petzäll et al., 2011; Sánchez-Mangas et al., 2010; Arroyo et al., 2013; Peura et al., 2015). Thus, the emergency medical handling of the injured has become an acknowledged tactical approach for reducing the mortality rate from traumas, as many deaths would have been preventable if the victims had received quicker medical responses (Hussain and Redmond, 1994), especially in cases of brain- or heart-injured victims (MacLeod et al., 2007) or those requiring open airways or hemorrhage controls (Bansal et al., 2009; Bakke and Wisborg, 2017; Oliver et al., 2017). Many studies have been motivated by the goal of figuring out the detailed and specific influencing patterns of EMS response times on rescue results, because of this and because of the significant financial cost associated with lowering EMS response times (Pons and Markovchick, 2002).
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