INVESTIGATING TRAUMATIC DEATHS

Investigating Traumatic Deaths

Investigating Traumatic Deaths

Introduction

Trauma remains a leading global cause of death. Knowledge of the epidemiological characteristics of trauma deaths is the backbone for trauma care planning, injury prevention, and systems improvements. In addition, this knowledge serves as an extremely useful baseline for determining health policy by directors of public health and for writing legislation at both the local and national levels. Seminal reports have set standards for textbook truisms and generated terms such as the “golden hour” and “trimodal distribution.” However, epidemiologic data from the past decades have yielded conflicting results, reflecting great geographic, socioeconomic, and regional differences. In particular, when investigating the principle of trimodal death distribution, several authors have challenged the validity of this measure, both from the North American and the European perspectives. Obviously, heterogeneity in the results from these studies makes general applicability difficult. In addition, autopsy rates as low as 10%, and rarely exceeding 60% in trauma, may further underscore the true injury spectrum in trauma deaths.

Reliable data on fatal trauma epidemiology is imperative for planning current and future trauma care in Europe. Although much can be learned from regional or national trauma registries, these data often preclude the availability and critical revision of autopsy data. Consequently, we sought to investigate the epidemiology of all trauma deaths over time in a representative North-European population, within a geographically defined area, and with a reliably high autopsy rate. Our primary aims were to document the demographic factors, the predominant injury mechanisms and severity, the causes of death, and the time distribution from injury to death after trauma.

Materials and Methods

Study Population

All trauma deaths occurring in the Stavanger area during a 9-year period were reviewed, beginning 1 January 1996 and ending 31 December 2004. Stavanger University Hospital (SUH) serves as the only primary trauma care facility for a mixed urban/rural population-based region of 290,000 inhabitants, and it covers trauma for a wider population approximating half a million. Annually, the SUH receives >300 patients whose Injury Severity Score (ISS) is = 10 and/or whose injury mechanism require trauma team activation by preset criteria, as previously reported. About one quarter (80-85 patients/year) of all annual trauma admissions are severely injured patients with an ISS = 16 (unpublished data from SUH Trauma Registry). The pre-hospital emergency medicine service (EMS) system is based on paramedic-manned ambulances, in addition to an anaesthesiologist-manned rapid-response car and helicopter system (HEMS), as previously described. The hospital has a designated trauma team, which responds within 5 min of activation and is present in the trauma resuscitation room in the Emergency Department when the patient arrives. The team leader is the senior surgical resident on-call. Consultant specialists (i.e., neurosurgery, vascular and thoracic, or gastroenterologic surgeons) are present by priority or are called in on a rapid-response basis (15 min) outside office hours.

To justify an epidemiological approach to a defined population of trauma deaths, the study population was limited to trauma deaths occurring within the Stavanger community area (with 290,000 inhabitants) and included victims holding residency within the ...