Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns, 1997-2008.
BACKGROUND
Advances in care such as damage control surgery, hemostatic resuscitation, protocol-driven cerebral perfusion management, and lung-protective ventilation have promised to improve survival after major trauma. We examined injury severity, mortality, and preventability in a mature trauma system during a 12-year period to assess the overall benefits of these and other improvements.


METHODS
Using the institutional trauma registry and the quality management database, we analyzed the outcome and the cause of death for all primary trauma admissions from July 1, 1996, to June 30, 2008, and linked these data with patient demographics, hospital length of stay, time to death, predicted probability of survival, and peer review of in-hospital deaths.


RESULTS
Through fiscal year (FY) 2007, primary trauma admissions increased in number, injury severity, and age. Performance benchmarked against predicted probability of survival improved. Mortality through this era ranged from 3% to 3.7% and worsened slightly overall (p = 0.04). However, among those patients admitted with Injury Severity Score 17-25, survival improved significantly (p = 0.0003). Traumatic brain injury (TBI) accounted for 51.6% of deaths; acute hemorrhage, 30%; and multiple organ failure, 10.5%. Median time to death for uncontrollable hemorrhage, TBI, multiple organ failure was 2 hours, 24 hours, and 15 days, respectively. These patterns did not change significantly over time.


CONCLUSIONS
Survival after severe trauma and survival benchmarked against predicted risk improved significantly at our center during the past 12 years despite generally increasing age and worsening injuries. Advances in trauma care have kept pace with an aging population and greater severity of injury, but overall survival has not improved.
Dutton
Richard P
RP
Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Stansbury
Lynn G
LG
Leone
Susan
S
Kramer
Elizabeth
E
Hess
John R
JR
Scalea
Thomas M
TM
D000328:Adult; D000367:Age Factors; D001930:Brain Injuries / Q000401:mortality; D002423:Cause of Death / Q000639:trends; D005260:Female; D006470:Hemorrhage / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008396:Maryland / Q000453:epidemiology; D009102:Multiple Organ Failure / Q000401:mortality; D012044:Regression Analysis; D016019:Survival Analysis; D013997:Time Factors; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy; D014949:Wounds, Nonpenetrating / Q000401:mortality; D014950:Wounds, Penetrating / Q000401:mortality