The why and how our trauma patients die: A prospective Multicenter Western Trauma Association study

被引：127

作者：

Callcut, Rachael A. ^{[1
]}

Kornblith, Lucy Z. ^{[1
]}

Conroy, Amanda S. ^{[1
]}

Robles, Anamaria J. ^{[1
]}

Meizoso, Jonathan P. ^{[2
]}

Namias, Nicholas ^{[2
]}

Meyer, David E. ^{[3
]}

Haymaker, Amanda ^{[3
]}

Truitt, Michael S. ^{[4
]}

Agrawal, Vaidehi ^{[4
]}

Haan, James M. ^{[5
]}

Lightwine, Kelly L. ^{[5
]}

Porter, John M. ^{[6
]}

San Roman, Janika L. ^{[6
]}

Biffl, Walter L. ^{[7
]}

Hayashi, Michael S. ^{[8
]}

Sise, Michael J. ^{[9
]}

Badiee, Jayraan ^{[9
]}

Recinos, Gustavo ^{[10
]}

Inaba, Kenji ^{[10
]}

Schroeppel, Thomas J. ^{[11
]}

Callaghan, Emma ^{[11
]}

Dunn, Julie A. ^{[12
]}

Godin, Samuel ^{[12
]}

McIntyre, Robert C. ^{[13
]}

Peltz, Erik D. ^{[13
]}

O'Neill, Patrick J. ^{[14
]}

Diven, Conrad F. ^{[14
]}

Scifres, Aaron M. ^{[15
]}

Switzer, Emily E. ^{[15
]}

West, Michaela A. ^{[16
]}

Storrs, Sarah ^{[16
]}

Cullinane, Daniel C. ^{[17
]}

Cordova, John F. ^{[17
]}

Moore, Ernest E. ^{[18
]}

Moore, Hunter B. ^{[18
]}

Privette, Alicia R. ^{[19
]}

Eriksson, Evert A. ^{[19
]}

Cohen, Mitchell Jay ^{[20
,21
]}

Manning, Ronald J. ^{[2
]}

Gutierrez, Tim ^{[4
]}

Deramo, Paul ^{[4
]}

Dunne, Casey E. ^{[9
,10
]}

Wong, Monica D.

Krell, Regina V. ^{[13
]}

Cross, Alisa M. ^{[14
]}

Butler, Cressilee ^{[15
]}

Moore, Cindy ^{[15
]}

Rumford, Richelle ^{[15
]}

机构：

[1] Univ Calif San Francisco, Zuckerberg San Francisco Gen Hosp, Dept Surg, San Francisco, CA 94143 USA

[2] Univ Miami, Jackson Mem Hosp, Miller Sch Med, Dept Surg, Miami, FL 33136 USA

[3] Univ Texas Hlth Sci Ctr Houston, McGovern Med Sch, Dept Surg, Houston, TX 77030 USA

[4] Methodist Dallas Med Ctr, Div Trauma & Acute Care, Dallas, TX USA

[5] Univ Kansas, Sch Med, Dept Trauma, Via Christi Hlth,Wichita Campus, Wichita, KS 67214 USA

[6] Cooper Univ Hosp, Div Trauma, Camden, NJ USA

[7] Scripps Mem Hosp La Jolla, Dept Surg, La Jolla, CA USA

[8] Univ Hawaii, Queens Med Ctr, Dept Surg, Honolulu, HI 96822 USA

[9] Scripps Mercy Hosp, Trauma Serv, San Diego, CA USA

[10] Los Angeles Cty Univ Southern Calif Med Ctr, Div Surg Crit Care & Trauma, Los Angeles, CA USA

[11] Univ Colorado Hlth, Dept Surg, Mem Hosp, Colorado Springs, CO USA

[12] Univ Colorado Hlth North, Med Ctr Rockies, Dept Surg, Loveland, CO USA

[13] Univ Colorado, Sch Med, Dept Surg, Aurora, CO USA

[14] Abrazo Med Grp, Dept Trauma & Gen Surg, Abrazo West Campus, Goodyear, AZ USA

[15] Univ Oklahoma, Dept Surg, Oklahoma City, OK USA

[16] North Mem Hlth Hosp, Div Trauma & Emergency Acute Care Surg, Robbinsdale, MN USA

[17] Marshfield Clin Fdn Med Res & Educ, Dept Surg, Marshfield, WI USA

[18] Univ Colorado, Denver Hlth Med Ctr, Dept Surg, Denver, CO 80202 USA

[19] Med Univ South Carolina, Dept Surg, Charleston, SC 29425 USA

[20] Denver Hlth Med Ctr, Dept Surg, Denver, CO USA

[21] Univ Colorado, Med Ctr, Aurora, CO USA

来源：

JOURNAL OF TRAUMA AND ACUTE CARE SURGERY | 2019年 / 86卷 / 05期

关键词：

Hemorrhage; cause of death; exsanguination; BLOOD-CELL TRANSFUSION; PREHOSPITAL DEATHS; MORTALITY; IMPACT;

D O I：

10.1097/TA.0000000000002205

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: Historically, hemorrhage has been attributed as the leading cause (40%) of early death. However, a rigorous, real-time classification of the cause of death (COD) has not been performed. This study sought to prospectively adjudicate and classify COD to determine the epidemiology of trauma mortality. METHODS: Eighteen trauma centers prospectively enrolled all adult trauma patients at the time of death during December 2015 to August 2017. Immediately following death, attending providers adjudicated the primary and contributing secondary COD using standardized definitions. Data were confirmed by autopsies, if performed. RESULTS: One thousand five hundred thirty-six patients were enrolled with a median age of 55 years (interquartile range, 32-75 years), 74.5% were male. Penetrating mechanism (n = 412) patients were younger (32 vs. 64, p < 0.0001) and more likely to be male (86.7% vs. 69.9%, p < 0.0001). Falls were the most common mechanism of injury (26.6%), with gunshot wounds second (24.3%). The most common overall primary COD was traumatic brain injury (TBI) (45%), followed by exsanguination (23%). Traumatic brain injury was nonsurvivable in 82.2% of cases. Blunt patients were more likely to have TBI (47.8% vs. 37.4%, p < 0.0001) and penetrating patients exsanguination (51.7% vs. 12.5%, p < 0.0001) as the primary COD. Exsanguination was the predominant prehospital (44.7%) and early COD (39.1%) with TBI as the most common later. Penetrating mechanism patients died earlier with 80.1% on day 0 (vs. 38.5%, p < 0.0001). Most deaths were deemed disease-related (69.3%), rather than by limitation of further aggressive care (30.7%). Hemorrhage was a contributing cause to 38.8% of deaths that occurred due to withdrawal of care. CONCLUSION: Exsanguination remains the predominant early primary COD with TBI accounting for most deaths at later time points. Timing and primary COD vary significantly by mechanism. Contemporaneous adjudication of COD is essential to elucidate the true understanding of patient outcome, center performance, and future research. Copyright (c) 2019 Wolters Kluwer Health, Inc. All rights reserved.

引用

页码：864 / 870

页数：7

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