How Do Trauma Patients Die?

Comprised of 1,536 patients in an 18-center, prospective, observational study coordinated though the Western Trauma Association:

• Traumatic brain injury – 45.0%
• Exsanguination – 23.0%
• “Late physiologic collapse” – 15.6%
• “Early physiologic collapse.” – 9.7%
• Pre-trauma medical event. – 3.8%
• Airway issue. – 1.5%
• Sudden unexpected event. – 1.0%

Unpacking the details, there are a handful of anticipated associations. Exanguination patients made up a much larger proportion of penetrating trauma patients. TBI proportion was actually only slightly higher in blunt trauma patients, but penetrating TBI was more likely to be deemed non-survivable on initial presentation. Almost half the deaths in penetrating trauma patients were in the Emergency Department – which also reflects a high proportion of pre-hospital arrest – followed by another quarter in the OR. Blunt trauma patients typically survived admission to the hospital. All patients for whom a pre-trauma medical event was determined to the causative factor were in the blunt trauma cohort, rather than penetrating.

There isn’t anything specifically prescriptive in this descriptive study, but it’s a building block for designing interventions in attempts to address the causes and timeframes of preventable death from trauma.

“The Why & How Our Trauma Patients Die: A Prospective Multi-center Western Trauma Association Study”
https://www.ncbi.nlm.nih.gov/pubmed/30633095