title: Overall distribution of trauma-related deaths in Berlin 2010: advancement or stagnation of German trauma management?
abstract: BACKGROUND
  Trauma is the leading cause of death among children, adolescents, and young adults. The latest data from the German Trauma Registry reveals a constant decrease in trauma mortality, indicating that 11.6 % of all trauma patients in 2010 died in hospital. Notably, trauma casualties dying before admission to hospital have not been systematically surveyed and analyzed in Germany.
  
  
  METHODS
  We conducted a prospective observational study of all traumatic deaths in Berlin, recording demographic data, trauma mechanisms, and causes/localization and time of death after trauma. Inclusion criteria were all deaths following trauma from 1 January 2010 to 31 December 2010.
  
  
  RESULTS
  A total of 440 trauma fatalities were included in this study, with a mortality rate of 13/100,000 inhabitants; 78.6 % were blunt injuries, and fall from a height >3 m (32.7 %) was the leading trauma mechanism. 32.5 % died immediately, 23.9 % died within 60 min, 7.7 % died within 1-4 h, 16.8 % died within 4-48 h, 11.1 % died <1 week later, and 8 % died >1 week after trauma. The predominant causes of death were polytrauma (45.7 %), sTBI (38 %), exsanguination (9.5 %), and thoracic trauma (3.2 %). Death occurred on-scene in 58.7 % of these cases, in the intensive care unit in 33.2 %, and in 2.7 % of the cases, in the emergency department, the operating room, and the ward, respectively.
  
  
  CONCLUSIONS
  Polytrauma is the leading cause of death, followed by severe traumatic brain injury (sTBI). The temporal analysis of traumatic death indicates a shift from the classic "trimodal" distribution to a new "bimodal" distribution. Besides advances in road safety, prevention programs and improvement in trauma management-especially the pre-hospital phase-have the potential to significantly improve the survival rate after trauma.
authors.affiliation: Center for Musculoskeletal Surgery, AG Polytrauma, Charité-Universitätsmedizin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany. christian.kleber@charite.de
authors.forename: Christian
authors.initials: C
authors.lastname: Kleber
authors.forename: Moritz T
authors.initials: MT
authors.lastname: Giesecke
authors.forename: Michael
authors.initials: M
authors.lastname: Tsokos
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Haas
authors.forename: Klaus D
authors.initials: KD
authors.lastname: Schaser
authors.forename: Poloczek
authors.initials: P
authors.lastname: Stefan
authors.forename: Claas T
authors.initials: CT
authors.lastname: Buschmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001604:Berlin / Q000453:epidemiology; D001930:Brain Injuries / Q000209:etiology / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000209:etiology / Q000401:mortality; D011446:Prospective Studies; D012042:Registries; D014947:Wounds and Injuries / Q000209:etiology / Q000401:mortality*; D055815:Young Adult