EPIDEMIOLOGY OF IMMEDIATE AND EARLY TRAUMA DEATHS AT AN URBAN LEVEL-ITRAUMA CENTER

The objective of this study is to identify and differentiate the injur y patterns and causes of death among patients who died within the Ist hour and those in the period between 1 and 48 hours after hospital adm ission. Information was collected from the 1994 to 1996 trauma data ba se at an urban Level I trauma center. The records of 155 trauma patien ts who died within the Ist hour (immediate trauma death, ITD) and betw een I and 48 hours (early trauma death, ETD) were examined retrospecti vely. Total and constituent Injury Severity Score (ISS), Trauma Score (TS), and Glasgow Coma Score were analyzed. ITDs constituted 49 per ce nt of all deaths within 48 hours. Blunt mechanisms accounted for 37 pe r cent of ITDs and 40 per cent of ETDs (not significant), whereas pene trating trauma accounted for 59 per cent of ITDs and 56 per cent of ET Ds (not significant). Exsanguination most commonly caused death among ITDs (54%) and head injury (51%) among ETDs (P < 0.01). Patients who d ied within the 1st hour had higher ISS (42.6 +/- 23.2, P < 0.03), lowe r TS (1.7 +/- 1.9, P < 0.0001), and lower Glasgow Coma Score (3.1 +/- 1.1, P < 0.0001) than those who died after the 1st hour. Patients with ITD had a significantly worse chest ISS than those with ETD (47.4 +/- 28.6 vs 19.0 +/- 19.1, P < 0.0001). We conclude that 1) ITD is caused primarily by exsanguination, whereas ETD is largely due to the sequel ae of severe neurologic injury; 2) ITD has a significantly lower TS an d higher ISS than ETD; and 3) thoracic injuries are more severe among patients with ITDs than among those with ETDs. The severity of thoraci c injury among ITDs suggests that rapid surgical intervention is criti cal during the resuscitation of these severely injured patients.