title: Epidemiology and outcomes of non-compressible torso hemorrhage.
abstract: BACKGROUND
  Non-compressible torso hemorrhage (NCTH) is the leading cause of potentially preventable death in military trauma, but the civilian epidemiology is unknown. The aim of this study is to apply a military definition of NCTH, which incorporates anatomic and physiological criteria, to a civilian population treated at trauma centers in the US.
  
  
  METHODS
  Patients (age >16 y) from 197 Level 1 trauma centers (approximately 95% of all US Level 1 centers) in the National Trauma Data Bank 2007-2009 that sustained a named torso vessel injury, pulmonary injury, grade IV solid organ injury, or pelvic fracture with ring disruption were included. Of these, patients with a systolic blood pressure <90 mmHg were considered to have NCTH. Multivariable logistic regression was used to identify patient and injury factors associated with NCTH and mortality after adjusting for the following covariates: patient (age, gender, ethnicity, and insurance status), injury (Glasgow Coma Scale, injury type, Injury Severity Score, anatomic region), and clinical (major surgical procedure, need for transfusion, and intensive care unit admission) characteristics.
  
  
  RESULTS
  Of the 1.8 million patients in the 2007-2009 National Trauma Data Bank, 249,505 met the anatomic criteria for non-compressible torso injury (NCTI). Of these, 20,414 (8.2%) patients had associated hemorrhage. The rate of pulmonary and torso vessel injury was similar (53.4% and 50.6%, respectively), with solid organ injury identified in 27.0% of patients and pelvic injury in 8.9%. The overall mortality rate of patients with NCTI and NCTH was 6.8% and 44.6%, respectively. The most lethal injury was major torso vessel injury (OR 1.54, 95% CI 1.33-1.78), followed by pulmonary injury (OR 1.32, 95% CI 1.18-1.48). Lower mortality was found in patients with pelvic injury (OR 0.80, 95% CI 0.65-0.98).
  
  
  CONCLUSIONS
  The military definition of NCTH can be usefully applied to civilians to identify patients with lethal injuries and high resource needs. Investigating the implications of NCTH on patient triage is recommended.
authors.affiliation: Department of Surgery, University of Arizona, Tucson, Arizona, USA.
authors.forename: Mehreen
authors.initials: M
authors.lastname: Kisat
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Morrison
authors.forename: Zain G
authors.initials: ZG
authors.lastname: Hashmi
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: Todd E
authors.initials: TE
authors.lastname: Rasmussen
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D006470:Hemorrhage / Q000453:epidemiology* / Q000628:therapy; D006491:Hemothorax / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D055370:Lung Injury / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology* / Q000628:therapy; D015999:Multivariate Analysis; D010384:Pelvic Bones / Q000293:injuries; D012042:Registries / Q000706:statistics & numerical data; D060726:Torso / Q000293:injuries; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D055815:Young Adult
keywords: Critical care; Hemorrhage; Trauma epidemiology; Trauma surgery