Late death after multiple severe trauma: when does it occur and what are the causes?
BACKGROUND
The information about the long-term mortality and causes of death after multiple injuries is sparse. In general, most follow-up studies report on 1 year to 3 years maximum follow up. The current literature focuses on causes of death immediately after trauma or during the initial in-hospital stay. We report on long-term mortality and causes of death in patients with multiple injures up to 30 years after the initial injury.


METHODS
We analyzed the causes of death using patient files, inquiries of patients' relatives, and death certificates. Inclusion criteria are (1) polytrauma (PT) (Injury Severity Score > or = 16) between 1973 and 1990; (2) age 3 years to 60 years at injury; (3) admission to the hospital alive; and (4) death during the study period. Patients were separated into two groups: patients deceased during the initial hospital stay (in-hospital deaths, n = 408) and patients deceased after discharge (postdischarge deaths, n = 103). The survival of the PT victims was compared descriptively with age- and gender-matched data from the general population (GP).


RESULTS
Causes of death in in-hospital deaths are head injury (37%), adult respiratory distress syndrome (14%), sepsis (11%), hemorrhagic shock (10%), pneumonia (9%), multiple organ failure (9%), and others (10%). Causes of death after discharge included cardiovascular diseases (23%), second major trauma (19%), neurologic diseases (16%), suicide (10%), malignancies (6%), and others (26%). The analysis of survival showed a higher mortality for PT compared with the GP group during the first year after the event (p < 0.05). Between 2 years and 10 years after the event, the annual mortality of the PT-group approximates the GP group.


CONCLUSIONS
PT patients who die after discharge from the initial hospitalization show other causes of death than age-matched controls of the general population. Among these are second major trauma and suicide. Future studies should investigate whether certain social or psychologic factors might play a role.
Department of Orthopaedic Trauma, Hannover Medical School, Hannover, Germany. Probst.Christian@mh-hannover.de
Christian
C
Probst
Boris A
BA
Zelle
Nicola A
NA
Sittaro
Ralf
R
Lohse
Christian
C
Krettek
Hans C
HC
Pape
D000293:Adolescent; D000328:Adult; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality*; D013997:Time Factors; D055815:Young Adult