Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution
Objective: To characterize the pattern of mortality for major trauma patients. Methods: Retrospective study of major trauma patients admitted in a Level I trauma center, during the latest 5 years was conducted. Selection criteria included (1) injury severity score (ISS) > 16 and (2) in-hospital d...
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doaj-905a9bec294e4cb194caa6fa8bf563da2020-11-24T21:04:50ZengWolters Kluwer Medknow PublicationsJournal of Acute Disease2221-61892015-08-014320520910.1016/j.joad.2015.03.001Mortality after acute trauma: Progressive decreasing rather than a trimodal distributionIonut Negoi0Sorin Paun1Sorin Hostiuc2Bogdan Stoica3Ioan Tanase4Ruxandra Irina Negoi5Gabriel Constantinescu6Mircea Beuran7University of Medicine and Pharmacy Carol Davila Bucharest, RomaniaUniversity of Medicine and Pharmacy Carol Davila Bucharest, RomaniaUniversity of Medicine and Pharmacy Carol Davila Bucharest, RomaniaEmergency Hospital of Bucharest, RomaniaEmergency Hospital of Bucharest, RomaniaUniversity of Medicine and Pharmacy Carol Davila Bucharest, RomaniaUniversity of Medicine and Pharmacy Carol Davila Bucharest, RomaniaUniversity of Medicine and Pharmacy Carol Davila Bucharest, RomaniaObjective: To characterize the pattern of mortality for major trauma patients. Methods: Retrospective study of major trauma patients admitted in a Level I trauma center, during the latest 5 years was conducted. Selection criteria included (1) injury severity score (ISS) > 16 and (2) in-hospital death. Results: There were 47 patients, with a mean age of 37.2 ± 19.9 years. The mean ISS was 37.6 ± 12.7 and the mean revised trauma score was 4.5 ± 2.2. Computed tomography scan on admission was done in 18 (38%) patients, 20% being hemodynamically unstable (P = 0.001). The diagnostic peritoneal lavage was performed in 10 (22%) cases, 23.3% being hemodynamically unstable (P > 0.05). The mean number of intraabdominal injuries was 3. The need for transfusion was 8.2 ± 6.7 units. The mean time to death was 4.9 days. Early death was secondary to hemorrhagic shock (HS) (ISS = 35.2 ± 15.9, P > 0.05, revised trauma score = 3.74 ± 2.70, P = 0.008) and multiple organ failure (ISS = 36.6 ± 14.1, P > 0.05, revised trauma score = 5.94 ± 1.34, P = 0.008) was the cause for later mortality. Combined liver and splenic injuries were found in 13 cases, with secondary death through HS in 5 and multiple system organ failure (MSOF) in 8 cases. Combined liver, splenic and kidney injuries were found in 5 cases (cause of death: HS 2 cases, MSOF 3 cases). A total of 14 patients had associated head, thorax, abdomen and extremity trauma (cause of death: cerebral trauma 6 cases, MSOF 5 cases, HS 2 cases); 5 patients had thorax and abdomen trauma (cause of death: HS 5 cases); 8 patients had thorax, abdomen and extremity trauma (cause of death: MSOF 5 cases, HS 3 cases); 3 patients had abdomen and extremity trauma (HS 2 cases). We did not find a trimodal time distribution for mortality. Conclusions: The trimodal time distribution of mortality remains a milestone in trauma education and research. Nevertheless, it must be questioned in the modern and very efficient trauma systems, but still very actual for developing trauma care systems. In conclusion, the pattern of mortality due to major trauma seems decreasing continuously with time rather than presenting high peaks of frequency at some moments.http://www.sciencedirect.com/science/article/pii/S2221618915000311PolytraumaMajor abdominal traumaMortality |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ionut Negoi Sorin Paun Sorin Hostiuc Bogdan Stoica Ioan Tanase Ruxandra Irina Negoi Gabriel Constantinescu Mircea Beuran |
spellingShingle |
Ionut Negoi Sorin Paun Sorin Hostiuc Bogdan Stoica Ioan Tanase Ruxandra Irina Negoi Gabriel Constantinescu Mircea Beuran Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution Journal of Acute Disease Polytrauma Major abdominal trauma Mortality |
author_facet |
Ionut Negoi Sorin Paun Sorin Hostiuc Bogdan Stoica Ioan Tanase Ruxandra Irina Negoi Gabriel Constantinescu Mircea Beuran |
author_sort |
Ionut Negoi |
title |
Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution |
title_short |
Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution |
title_full |
Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution |
title_fullStr |
Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution |
title_full_unstemmed |
Mortality after acute trauma: Progressive decreasing rather than a trimodal distribution |
title_sort |
mortality after acute trauma: progressive decreasing rather than a trimodal distribution |
publisher |
Wolters Kluwer Medknow Publications |
series |
Journal of Acute Disease |
issn |
2221-6189 |
publishDate |
2015-08-01 |
description |
Objective: To characterize the pattern of mortality for major trauma patients.
Methods: Retrospective study of major trauma patients admitted in a Level I trauma center, during the latest 5 years was conducted. Selection criteria included (1) injury severity score (ISS) > 16 and (2) in-hospital death.
Results: There were 47 patients, with a mean age of 37.2 ± 19.9 years. The mean ISS was 37.6 ± 12.7 and the mean revised trauma score was 4.5 ± 2.2. Computed tomography scan on admission was done in 18 (38%) patients, 20% being hemodynamically unstable (P = 0.001). The diagnostic peritoneal lavage was performed in 10 (22%) cases, 23.3% being hemodynamically unstable (P > 0.05). The mean number of intraabdominal injuries was 3. The need for transfusion was 8.2 ± 6.7 units. The mean time to death was 4.9 days. Early death was secondary to hemorrhagic shock (HS) (ISS = 35.2 ± 15.9, P > 0.05, revised trauma score = 3.74 ± 2.70, P = 0.008) and multiple organ failure (ISS = 36.6 ± 14.1, P > 0.05, revised trauma score = 5.94 ± 1.34, P = 0.008) was the cause for later mortality. Combined liver and splenic injuries were found in 13 cases, with secondary death through HS in 5 and multiple system organ failure (MSOF) in 8 cases. Combined liver, splenic and kidney injuries were found in 5 cases (cause of death: HS 2 cases, MSOF 3 cases). A total of 14 patients had associated head, thorax, abdomen and extremity trauma (cause of death: cerebral trauma 6 cases, MSOF 5 cases, HS 2 cases); 5 patients had thorax and abdomen trauma (cause of death: HS 5 cases); 8 patients had thorax, abdomen and extremity trauma (cause of death: MSOF 5 cases, HS 3 cases); 3 patients had abdomen and extremity trauma (HS 2 cases). We did not find a trimodal time distribution for mortality.
Conclusions: The trimodal time distribution of mortality remains a milestone in trauma education and research. Nevertheless, it must be questioned in the modern and very efficient trauma systems, but still very actual for developing trauma care systems. In conclusion, the pattern of mortality due to major trauma seems decreasing continuously with time rather than presenting high peaks of frequency at some moments. |
topic |
Polytrauma Major abdominal trauma Mortality |
url |
http://www.sciencedirect.com/science/article/pii/S2221618915000311 |
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