B. T. Oyeniyi1, E. E. Fox1, M. Scerbo1, J. S. Tomasek1, C. E. Wade1, J. B. Holcomb1 1University Of Texas Health Science Center At Houston,Acute Care Surgery/Surgery,Houston, TX, USA
Introduction: Over the last decade the age of trauma patients and injury mortality has increased. At the same time, we have implemented many interventions focused on improved hemorrhage control. The objective of our study was to analyze the temporal distribution of trauma-related deaths, the factors that characterize that distribution and how those factors have changed over time at our level 1 trauma center.
Methods: The trauma registry, weekly Morbidity & Mortality reports and electronic medical records at Memorial Hermann Hospital in Houston, TX were reviewed. Patients with primary burn injuries and pediatric age (<16) patients were excluded. Two time periods (2005-2006 and 2012-2013) were included in the analysis. Baseline characteristics, time and cause of death were recorded. Mortality rates were directly adjusted for age, gender and mechanism of injury. Results are expressed comparing 2005-2006 with 2012-2013. The Mann-Whitney and chi square tests were used to compare variables between periods, with significance set at the 0.05 level.
Results: 7080 patients including 498 deaths were examined in the early time period, while 8767 patients including 531 deaths were reviewed in the recent period. The median age increased 6 years between the two groups, with a similar increase in those who died, 46 (28-67) to 53 (32-73) (p<0.01) years. In patients that died, no differences by gender, race or ethnicity were observed. Fall-related deaths increased from 20% to 28% (p<0.01) while deaths due to motor vehicle collisions decreased from 39% to 25% (p<0.01). Deaths associated with hemorrhage decreased from 36% to 25% (p<0.01). 26% of all deaths (including dead on arrival, DOAs) occurred within one hour of hospital arrival, while 59% occurred within 24 hours, and were similar across time periods. Unadjusted overall mortality dropped from 7.0% to 6.1% (p=0.01) and in-hospital mortality (excluding DOA) dropped from 6.0% to 5.0% (p<0.01). Adjusted overall mortality dropped 24% from 7.6% (95% CI: 6.9-8.2) to 5.8% (95% CI: 5.3-6.3) and in-hospital mortality decreased 30% from 6.6% (95% CI: 6.0-7.2) to 4.7% (95% CI: 4.2-5.1).
Conclusion: Although US data show a 20% increase in death rate due to trauma over a similar time period, this single-site study demonstrated a significant reduction in adjusted overall and in-hospital mortality. It is possible that concentrated efforts on improving resuscitation and multiple other hemorrhage control interventions resulted in the observed reduction in hemorrhage related mortality. Most trauma deaths continue to be concentrated very soon after injury. We observed an aging trauma population and an increase in deaths due to falls. These changing factors provide guidance on potential future prevention and intervention efforts.