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Trauma trimodal mortality

Ernestina Gomes, Rui Araújo, António Carneiro, Cláudia Dias, Fiona E Lecky, Altamiro Costa-Pereira
INTRODUCTION: Trimodal distribution of deaths and the golden hour concepts are in part responsible for the genesis of all modern trauma systems but these concepts have been challenged recently. Our aim was to describe distribution of death in trauma using data from a trauma system and discuss what could be done from the organizational point of view to improve outcome. METHODS: We included all traumatic deaths occurring between 2001 and 2005 in a trauma system. Data on age, gender, time and place of injury, time of first and second hospital arrival, cause of trauma and type of accident, hospital characteristics, dominant injury and time of death were collected for this study...
December 2008: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
R Lefering, T Paffrath, O Bouamra, T J Coats, M Woodford, T Jenks, A Wafaisade, U Nienaber, F Lecky
PURPOSE: About half of all trauma-related deaths occur after hospital admission. The present study tries to characterize trauma deaths according to the time of death, and, thereby, contributes to the discussion about factors considered as the cause of death. METHODS: Data from two large European trauma registries (Trauma Registry of the German Society of Trauma Surgery, TR-DGU, and the Trauma Audit and Research Network, TARN) were analyzed in parallel. All hospital deaths with Injury Severity Score (ISS) > 9 documented between 2000 and 2010 were considered...
February 2012: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Carrie Valdez, Babak Sarani, Hannah Young, Richard Amdur, James Dunne, Lakhmir S Chawla
BACKGROUND: The trimodal distribution of traumatic death was first described by Trunkey in 1983, which demonstrated that most deaths occur in the first 24 h. We postulate that since 1983, the time-to-death histogram described has shifted. METHODS: A retrospective analysis identifying timing of death was conducted on the National Trauma Data Bank (version 7.2) from 2002 to 2006. Early death was defined as death within 24 h of admission. International Classification of Diseases ninth edition codes with greater than 20% early deaths were called "high-risk codes"...
February 2016: Journal of Surgical Research
E D Arslan, E Kaya, M Sonmez, C Kavalci, A Solakoglu, F Yilmaz, T Durdu, E Karakilic
Trauma management shows significant progress in last decades. Determining the time and place of deaths indicate where to focus to improve our knowledge about trauma. We conducted this retrospective study from data of trauma victims who were brought to a major tertiary hospital which is a level one trauma center in Ankara, Turkey, and died even if during transport or in the hospital between 1 March 2010 and 1 March 2013. The patients' demographic characteristics, trauma mechanisms, time frames and causes of deaths determined by physicians were recorded...
June 2015: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
J W Tee, C H P Chan, M C B Fitzgerald, S M Liew, J V Rosenfeld
Knowledge of current epidemiology and spine trauma trends assists in public resource allocation, fine-tuning of primary prevention methods, and benchmarking purposes. Data on all patients with traumatic spine injuries admitted to the Alfred Hospital, Melbourne between May 1, 2009, and January 1, 2011, were collected from the Alfred Trauma Registry, Alfred Health medical database, and Victorian Orthopaedic Trauma Outcomes Registry. Epidemiological trends were analyzed as a general cohort, with comparison cohorts of nonsurvivors versus survivors and elderly versus nonelderly...
June 2013: Global Spine Journal
Justin Sobrino, Shahid Shafi
Currently, long-term outcomes are significant because health care system changes will likely lead to a single payment for each occurrence of care, including readmissions-the "bundled payment" system. Therefore, it is essential to understand the outcomes of trauma patients discharged alive from trauma centers. This article reviews the current knowledge base on the timing and causes of deaths after trauma. The trimodal mortality model (immediate deaths, early deaths, and late deaths) is utilized as the early research describing trimodal distribution is discussed...
April 2013: Proceedings of the Baylor University Medical Center
Jordan W Swanson, Andrew M Otto, Nicole S Gibran, Matthew B Klein, C Bradley Kramer, David M Heimbach, Tam N Pham
BACKGROUND: With unprecedented survival rates in modern burn care, there is increasing focus on optimizing long-term functional outcomes. However, 3% to 8% of patients admitted to burn centers still die of injury. Patterns in which these patients progress to death remain poorly characterized. We hypothesized that burn nonsurvivors will follow distinct temporal distributions and patterns of decline, parallel to the trimodality of deaths previously described for trauma. METHODS: We retrospectively identified all adult deaths from 1995 to 2007 in the National Burn Repository database (n = 5,975) and at our regional burn center (n = 237)...
January 2013: Journal of Trauma and Acute Care Surgery
Christian Kleber, Moritz T Giesecke, Michael Tsokos, Norbert P Haas, Klaus D Schaser, Poloczek Stefan, Claas T Buschmann
BACKGROUND: Trauma is the leading cause of death among children, adolescents, and young adults. The latest data from the German Trauma Registry reveals a constant decrease in trauma mortality, indicating that 11.6 % of all trauma patients in 2010 died in hospital. Notably, trauma casualties dying before admission to hospital have not been systematically surveyed and analyzed in Germany. METHODS: We conducted a prospective observational study of all traumatic deaths in Berlin, recording demographic data, trauma mechanisms, and causes/localization and time of death after trauma...
September 2012: World Journal of Surgery
David E Clark, Jing Qian, Kristen C Sihler, Lee D Hallagan, Rebecca A Betensky
INTRODUCTION: The distribution of survival times after injury has been described as "trimodal," but several studies have not confirmed this. The purpose of this study was to clarify the distribution of survival times after injury. METHODS: We defined survival time (t(s)) as the interval between injury time and declared death time. We constructed histograms for t(s) ≤ 150 min from the 2004-2007 Fatality Analysis Reporting System (FARS, for traffic crashes) and National Violent Death Reporting System (NVDRS, for homicides)...
July 2012: World Journal of Surgery
Håkon Kvåle Bakke, Torben Wisborg
BACKGROUND: Finnmark County is the northernmost county in Norway. For several decades, the rate of mortality after injury in this sparsely inhabited region has remained above the national average. Following documentation of this discrepancy for the period 1991-1995, improvements to the trauma system were implemented. The present study aims to assess whether trauma-related mortality rates have subsequently improved. METHODS: All injury-associated fatalities in Finnmark from 1995-2004 were identified retrospectively from the National Registry of Death and reviewed...
July 2011: World Journal of Surgery
Mark Gunst, Vafa Ghaemmaghami, Amy Gruszecki, Jill Urban, Heidi Frankel, Shahid Shafi
Injury mortality was classically described with a trimodal distribution, with immediate deaths at the scene, early deaths due to hemorrhage, and late deaths from organ failure. We hypothesized that the development of trauma systems has improved prehospital care, early resuscitation, and critical care and altered this pattern. This population-based study of all trauma deaths in an urban county with a mature trauma system reviewed data for 678 patients (median age, 33 years; 81% male; 43% gunshot, 20% motor vehicle crashes)...
October 2010: Proceedings of the Baylor University Medical Center
Dane Chalkley, Grace Cheung, Michael Walsh, Nigel Tai
INTRODUCTION: Trauma data collection by UK hospitals is non-mandatory and data regarding trauma mortality are deficient. Our aim was to provide a contemporary description of mortality in a maturing trauma-receiving hospital serving an inner-city population. METHODS: A prospectively maintained registry was analysed for demographics; injury mechanism; and time, location and cause of death in trauma patients admitted via the Emergency Department between 2004 and 2008...
April 2011: Emergency Medicine Journal: EMJ
S Milanchi, I Makey, R McKenna, D R Margulies
BACKGROUND: The role of video-assisted Thoracoscopic Surgery (VATS) is still being defined in the management of thoracic trauma. We report our trauma cases managed by VATS and review the role of VATS in the management of thoracic trauma. MATERIALS AND METHODS: All the trauma patients who underwent VATS from 2000 to 2007 at Cedars-Sinai Medical Center were retrospectively studied. RESULTS: Twenty-three trauma patients underwent 25 cases of VATS...
July 2009: Journal of Minimal Access Surgery
Julie A Evans, Karlijn J P van Wessem, Debra McDougall, Kevin A Lee, Timothy Lyons, Zsolt J Balogh
BACKGROUND: The epidemiology of traumatic deaths was periodically described during the development of the American trauma system between 1977 and 1995. Recognizing the impact of aging populations and the potential changes in injury mechanisms, the purpose of this work was to provide a comprehensive, prospective, population-based study of Australian trauma-related deaths and compare the results with those of landmark studies. METHODS: All prehospitalization and in-hospital trauma deaths occurring in an inclusive trauma system at a single Level 1 trauma center [400 patients with an injury severity score (ISS) >15/year] underwent autopsy and were prospectively evaluated during 2005...
January 2010: World Journal of Surgery
Bahman S Roudsari, Mazyar Shadman, Mohammad Ghodsi
BACKGROUND: Only a few studies have addressed the trimodal distribution of childhood trauma fatalities in lesser developed countries. We conducted this study to evaluate pre-hospital, Emergency Department (ED) and in-hospital distribution of childhood injury-related death for each mechanism of injury in Tehran, Iran. This information will be used for the efficient allocation of the limited injury control resources in the city. METHODS: We used Tehran's Legal Medicine Organization (LMO) database...
2006: BMC Public Health
Stefano Di Bartolomeo, Gianfranco Sanson, Vanni Michelutto, Giuseppe Nardi, Ivana Burba, Carlo Francescutti, Luca Lattuada, Franca Scian et al.
OBJECTIVE: To provide reliable and comparable information on major injury (MIJ) (Injury Severity Score (ISS) > 15) by establishing a comprehensive and Utstein-style compliant registry of all occurrences in a defined geographical area. METHODS: Prospective, population-based, 12-month study targeting the 1,200,000 inhabitants of the Italian region Friuli Venezia Giulia (FVG). Deliberate self-harm was excluded. RESULTS: The total number of MIJ cases was 627, the resulting incidence 522 per million per year...
April 2004: Injury
D Beard, J M Henry, P T Grant
The Scottish Trauma Audit Group was established in 1991 to observe and improve the management of seriously injured patients in four Scottish teaching hospitals. There are currently 25 hospitals contributing to the national database. This prospective audit monitors the management of approximately 98% of seriously injured patients in Scotland. This report presents an analysis of the management of 23479 patients who were admitted to hospital for at least three days or who died in hospital as a result of their injuries...
March 2000: Health Bulletin
J L Lambert, G Hartstein, A Ghuysen, V D'Orio
Almost twenty years ago, Trunkey showed that deaths due to trauma followed a trimodal distribution over time. Half of these deaths were delayed by at least one to two hours after the initiating insult. This interval (the "golden hour") can be exploited, especially in specialized trauma centers (where the most severely injured patients are cared for), to aggressively treat these patients, thereby reducing morbidity and mortality. In Belgium, this hierarchy of trauma care centers is non-existent; patients are distributed within the healthcare system randomly, depending on the localisation of the accident and the directives of the unified "100" call centre...
March 2001: Revue Médicale de Liège
A Scope, U Farkash, M Lynn, A Abargel, A Eldad
PURPOSE: an analysis of the mortality epidemiology in low-intensity warfare. BASIC PROCEDURES: we retrospectively reviewed all cases of Israeli soldiers killed in small-scale warfare during 1996-1998, using field data, hospital charts and autopsy reports. Data on injury pattern, offending munitions and time of death were analyzed. MAIN FINDINGS: in the study period, 106 soldiers were killed. Penetrating trauma was the common injury mechanism (95%) most frequently due to claymore bombs and gunshot bullets...
January 2001: Injury
O N Gofrit, D Leibovici, S C Shapira, J Shemer, M Stein, M Michaelson
INTRODUCTION: Mortality in war is traditionally divided into two categories: killed in action and died of wounds. Mortality in civilian trauma is generally divided into three categories: immediate death (50%), early death (30%), and late death (20%). Can we identify a trimodal death distribution among war victims? METHODS: We analyzed data for casualties in the Lebanon War from June 6 to September 20, 1982. During this period a total of 1,950 soldiers were injured; 351 (18%) of them died...
January 1997: Military Medicine
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