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Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution
Authors: Ionut Negoi, Sorin Paun, Sorin Hostiuc, Bogdan Stoica, Ioan Tanase, Ruxandra Irina Negoi, Gabriel Constantinescu, Mircea Beuran
Number of views: 416
Objective: To characterize the pattern of mortality for major trauma patients.
Methods: Retrospective study of major trauma patients admitted in a Level I trauma
center, during the latest 5 years was conducted. Selection criteria included (1) injury
severity score (ISS) > 16 and (2) in-hospital death.
Results: There were 47 patients, with a mean age of 37.2 ± 19.9 years. The mean ISS
was 37.6 ± 12.7 and the mean revised trauma score was 4.5 ± 2.2. Computed tomography
scan on admission was done in 18 (38%) patients, 20% being hemodynamically unstable
(P = 0.001). The diagnostic peritoneal lavage was performed in 10 (22%) cases, 23.3%
being hemodynamically unstable (P > 0.05). The mean number of intraabdominal injuries was 3. The need for transfusion was 8.2 ± 6.7 units. The mean time to death was 4.9
days. Early death was secondary to hemorrhagic shock (HS) (ISS = 35.2 ± 15.9, P > 0.05,
revised trauma score = 3.74 ± 2.70, P = 0.008) and multiple organ failure
(ISS = 36.6 ± 14.1, P > 0.05, revised trauma score = 5.94 ± 1.34, P = 0.008) was the
cause for later mortality. Combined liver and splenic injuries were found in 13 cases, with
secondary death through HS in 5 and multiple system organ failure (MSOF) in 8 cases.
Combined liver, splenic and kidney injuries were found in 5 cases (cause of death: HS 2
cases, MSOF 3 cases). A total of 14 patients had associated head, thorax, abdomen and
extremity trauma (cause of death: cerebral trauma 6 cases, MSOF 5 cases, HS 2 cases); 5
patients had thorax and abdomen trauma (cause of death: HS 5 cases); 8 patients had
thorax, abdomen and extremity trauma (cause of death: MSOF 5 cases, HS 3 cases); 3
patients had abdomen and extremity trauma (HS 2 cases). We did not find a trimodal time
distribution for mortality.
Conclusions: The trimodal time distribution of mortality remains a milestone in trauma
education and research. Nevertheless, it must be questioned in the modern and very
efficient trauma systems, but still very actual for developing trauma care systems. In
conclusion, the pattern of mortality due to major trauma seems decreasing continuously
with time rather than presenting high peaks of frequency at some moments.