title: Preventable deaths from hemorrhage at a level I Canadian trauma center.
abstract: BACKGROUND
  Studies of trauma deaths have had a tremendous impact on the quality of contemporary trauma care. We studied causes of trauma death at a Level I Canadian trauma center, and tabulated preventable deaths from hemorrhage using explicit criteria.
  
  
  METHODS
  Trauma registry data were used to identify all trauma deaths at our institution from January 1, 1999 to December 31, 2003. Demographics, mechanism, and time or location of death were recorded. Registry data analysis and selective chart or autopsy review were then performed to assign causes of death.
  
  
  RESULTS
  A total of 558 consecutive trauma deaths were reviewed. Mean age was 48.7 (46.7-50.6), and mean Injury Severity Score was 38.8 (37.6-40.0); 29% were females. Blunt trauma represented 87% of all cases; penetrating injuries were only 13%. Central nervous system (CNS) injuries were the most frequent cause of death (60%), followed by hemorrhage (15%), and then combination CNS and hemorrhagic injuries (11%). Multiple organ failure caused 5% of deaths and 9% of deaths were from other causes. Of hemorrhagic deaths, 48% (n = 41) were from blunt injury, and 52% (n = 45) were from a penetrating mechanism. Of these hemorrhagic deaths, 16% were judged to be preventable because of significant delays in identifying the major source of hemorrhage. Hemorrhage from blunt pelvic injury was the major cause of exsanguination in 12 of 14 of these preventable deaths.
  
  
  CONCLUSIONS
  Blunt injury is the major mechanism leading to trauma deaths. Massive bleeding from blunt pelvic injury is the major cause of preventable hemorrhagic deaths in our study.
authors.affiliation: Canadian Forces Health Services Group, Department of National Defense, Toronto, Canada. homer.tien@sunnybrook.ca
authors.forename: Homer C
authors.initials: HC
authors.lastname: Tien
authors.forename: Fernando
authors.initials: F
authors.lastname: Spencer
authors.forename: Lorraine N
authors.initials: LN
authors.lastname: Tremblay
authors.forename: Sandro B
authors.initials: SB
authors.lastname: Rizoli
authors.forename: Frederick D
authors.initials: FD
authors.lastname: Brenneman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011787:Quality of Health Care; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality*