Hemorrhage is More Prevalent than Brain Injury in Early Trauma Deaths: The Golden Six Hours

被引:54
作者
Bansal, Vishal [1 ]
Fortlage, Dale [1 ]
Lee, Jeanne G. [1 ]
Costantini, Todd [1 ]
Potenza, Bruce [1 ]
Coimbra, Raul [1 ]
机构
[1] Univ Calif San Diego, Dept Surg, Div Trauma Burns & Crit Care, San Diego, CA 92103 USA
关键词
Trauma; Autopsy; Mortality; Hemorrhage; Brain injury; BLUNT TRAUMA; TIME; EPIDEMIOLOGY; FATALITIES;
D O I
10.1007/s00068-008-8080-2
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: Under the trimodal distribution, most trauma deaths occur within the first hour. Determination of cause of death without autopsy review is inaccurate. The goal of this study is to determine cause of death, in hourly intervals, in trauma patients who died in the first 24 h, as determined by autopsy. Materials and Methods: Trauma deaths that occurred within 24 h at a Level I trauma center were reviewed over a six-year period ending December 2005. Timing of death was separated into 0-1, 1-3, 3-6, 6-12 and 12-24 h intervals. Cause of death was determined by clinical course and AIS scores, and was confirmed by autopsy results. Results: Overall, 9,388 trauma patients were admitted, of which 185 deaths occurred within 24 h, with 167 available autopsies. Blunt and penetrating were the injury mechanisms in 122 (73%) and 45 (27%) patients, respectively. Of 167 deaths, 73 (43.7%) occurred within the first hour. Brain injury, when compared to other body areas, was the most likely cause of death in all hourly intervals, but hemorrhage was as or more important than brain injury as the cause of death during the first 3 h and up to 6 h. No deaths were attributable to hemorrhage after 12 h. Conclusions: The temporal distribution of the cause of death varies in the first 24 h after admission. Hemorrhage should not be overlooked as the cause of death, even after survival beyond 1 h. Understanding the temporal relationship of causes of early death can aid in the targeting of management and surgical training to optimize patient outcome.
引用
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页码:26 / 30
页数:5
相关论文
共 15 条
  • [1] Lethal injuries and time to death in a level I trauma center
    Acosta, JA
    Yang, JC
    Winchell, RJ
    Simons, RK
    Fortlage, DA
    Hollingsworth-Fridlund, P
    Hoyt, DB
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 1998, 186 (05) : 528 - 533
  • [2] Guidelines for the Management of Severe Traumatic Brain Injury: Editor's commentary
    Bullock, M. Ross
    Povlishock, John T.
    [J]. JOURNAL OF NEUROTRAUMA, 2007, 24 : VII - VIII
  • [3] Trauma deaths in a mature urban trauma system: Is "trimodal" distribution a valid concept?
    Demetriades, D
    Kimbrell, B
    Salim, A
    Velmahos, G
    Rhee, P
    Preston, C
    Gruzinski, G
    Chan, L
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2005, 201 (03) : 343 - 348
  • [4] Trauma fatalities: Time and location of hospital deaths
    Demetriades, D
    Murray, J
    Charalambides, K
    Alo, K
    Velmahos, G
    Rhee, P
    Chan, L
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2004, 198 (01) : 20 - 26
  • [5] Flaherty S, 2003, J TRAUMA, V54, P70
  • [6] Hodgson NF, 2000, CAN J SURG, V43, P130
  • [7] The utility of Sonography for the triage of blunt abdominal trauma patients to exploratory laparotomy
    Lee, Brett C.
    Ormsby, Eleanor L.
    McGahan, John P.
    Melendres, Giselle M.
    Richards, John R.
    [J]. AMERICAN JOURNAL OF ROENTGENOLOGY, 2007, 188 (02) : 415 - 421
  • [8] Trauma deaths in the first hour: are they all unsalvageable injuries?
    MacLeod, Jana B. A.
    Cohn, Stephen M.
    Johnson, E. William
    McKenney, Mark G.
    [J]. AMERICAN JOURNAL OF SURGERY, 2007, 193 (02) : 195 - 199
  • [9] Fatal trauma: The modal distribution of time to death is a function of patient demographics and regional resources
    Meislin, H
    Criss, EA
    Judkins, D
    Berger, R
    Conroy, C
    Parks, B
    Spaite, DW
    Valenzuela, TD
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1997, 43 (03) : 433 - 440
  • [10] Association between a positive ED FAST examination and therapeutic laparotomy in normotensive blunt trauma patients
    Moylan, Mark
    Newgard, Craig D.
    Ma, O. John
    Sabbaj, Alfredo
    Rogers, Tracy
    Douglass, Rachelle
    [J]. JOURNAL OF EMERGENCY MEDICINE, 2007, 33 (03) : 265 - 271