Triage and mortality in 2875 consecutive trauma patients.
BACKGROUND
Most studies on trauma and trauma systems have been conducted in the United States. We aimed to describe the factors predicting mortality in European trauma patients, with focus on triage.


METHODS
We prospectively registered all trauma patients in Eastern Denmark over 12 consecutive months. We analysed the flow of trauma patients through the system, the time spent at different locations, and we assessed the risk factors of mortality.


RESULTS
We included 2875 trauma patients, of whom 158 (5.5%) died before arrival at the hospital. Most patients (75.3%) were brought to local hospitals and patients primarily (n=82) or secondarily triaged (n=203) to the level I trauma centre were the most severely injured. Secondarily transferred patients spent a median of 150 min in the local hospital before transfer to the level I trauma centre and 48 min on transportation. Severe injury with an injury severity score >15 was seen in 345 patients, of whom 118 stayed at the local hospital. They had a significantly higher mortality than 116 of those secondarily transferred [45/118, 38.1% vs. 11/116, 9.7% (P<0.0001)]. Mortality within 30 days was 4.3% in admitted patients, and significant risk factors of death were violence [odds ratio (OR)=5.72], unconsciousness (OR=4.87), hypotension (OR=4.96), injury severity score >15 (OR=27.42), and age.


CONCLUSIONS
Around 50% of all trauma deaths occurred at the scene. Increased survival of severely injured patients may be achieved by early transfer to highly specialised care.
Meisler
R
R
Department of Anaesthesia, HOC 4231, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. rikkemeisler@hotmail.com
Thomsen
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AB
Abildstrøm
H
H
Guldstad
N
N
Borge
P
P
Rasmussen
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SW
Rasmussen
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LS
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D006259:Craniocerebral Trauma / Q000453:epidemiology / Q000401:mortality; D003718:Denmark / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007022:Hypotension / Q000401:mortality; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000453:epidemiology / Q000401:mortality; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data; D014218:Triage / Q000706:statistics & numerical data*; D014474:Unconsciousness / Q000401:mortality; D014754:Violence / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000453:epidemiology / Q000401:mortality*; D055815:Young Adult