LETHAL INJURIES AND TIME TO DEATH IN A LEVEL-I TRAUMA CENTER

Background: The purpose of this study was to identify the causes and t ime to death of all trauma victims who died at a level I trauma center during an 11-year period. Study Design: Autopsies were performed on a ll patients who died secondary to trauma. Retrospective review of thes e autopsies was carried out and appended to existing trauma registry d ata. Standard definitions were used to attribute the cause of death in each case. Preventable deaths were determined by a standardized peer review process. Results: Between January 1985 and December 1995, a tot al of 900 trauma patients died. This represented 7.3% of all major tra uma admissions (12,320). Seventy percent of these patients died within the first 24 hours of admission. Thoracic vascular and central nervou s system (CNS) injuries were the most common causes of death in the fi rst hour after admission to the hospital. CNS injuries were the most c ommon causes of death within the 72 deaths after admission. Acute infl ammatory processes (multiple organ failure, acute respiratory distress syndrome, and pneumonia) and pulmonary emboli mere the leading causes of death after the first 72 hours. Overall, 43.6% (393 of 900) of all trauma deaths mere caused by CNS injuries, making this the most commo n cause of death in our study. The preventable death rate was 1%. Conc lusions: The first 24 hours after trauma are the deadliest for these p atients. Primary and secondary CNS injuries are the leading causes of death. Prevention, early identification, and treatment of potentially lethal injuries should remain the focus of those mho treat trauma pati ents. (C) 1998 by the American College of Surgeons.