Late deaths in multiple trauma patients receiving intensive care

We reviewed the cause and timing of death of all the patients who died with in hospital following multiple trauma and admission to a multidisciplinary intensive care unit (ICU) that also acts as a tertiary referral centre, for neurosurgery. The ICU database identified 101 such patients in a 3-year pe riod and their records were reviewed retrospectively. There were 40 (39%) d eaths within 24 h of admission to the ICU, 38 of which resulted from severe brain injury and two from haemorrhagic shock (HS). A further 61 (60%) deat hs occurred more than 24 h after the time of admission to ICU (mean 7 days; range 2-49 days), of which 46 (75%) were due to severe brain injury. While these findings do not question the promulgated tri-modal distribution of d eath following trauma, they are at variance with the view that the third pe ak of deaths is due mainly to multiple organ failure. When severe head inju ry accompanies multiple trauma, it is likely to be the major determinant of late mortality. If outcome from major trauma is to be improved, then a gre ater emphasis needs to be placed on the prevention and optimal management o f severe brain injury. (C) 2001 Elsevier Science Ireland Ltd. All rights re served.