title: Clinical review is essential to evaluate 30-day mortality after trauma.
abstract: BACKGROUND
  Securing high-quality mortality statistics requires systematic evaluation of all trauma deaths. We examined the proportion of trauma patients dying within 30 days from causes not related to the injury and the impact of exclusion of patients dead on arrival on 30-day trauma mortality. We also defined the demographics, injury characteristics, cause of death and time to death in patients admitted to our trauma center who died within 30 days, between 2007-2011.
  
  
  METHODS
  Demographics, injury characteristics, status alive/dead on arrival, cause of death and time to death of all patients were reviewed. Deaths were analyzed based on injury mechanism (penetrating, blunt trauma and low energy blunt trauma) and cause of death (traumatic brain injury (TBI), hemorrhage, organ dysfunction and other/unknown).
  
  
  RESULTS
  Of the 7422 admissions, 343 deaths were identified of which 36 (10.5%) involved causes not related to the injury. The overall age was 71 years, Injury Severity Score (ISS) 29 and time to death 24 hours (all medians). Fifty-four patients (17.6%) were dead on arrival. Exclusion of patients dead on arrival reduced the overall mortality rate (P < 0.05) and median ISS (P < 0.05) and increased median age (P < 0.01) and time to death (P < 0.001). Injury mechanism was penetrating trauma in 7.5%, blunt trauma in 56.0%, and low energy blunt trauma in 36.5%. TBI accounted for 58.6%; hemorrhage 16.3%, organ dysfunction 15.0%, and other/unknown for 10.1% of the deaths. Patients who died after low energy blunt trauma were older, had lower ISS and longer time to death compared to those who died after penetrating and blunt trauma (all P < 0.01).
  
  
  CONCLUSIONS
  Clinical review of all trauma deaths was essential to interpret mortality. Thirty-day trauma mortality included 10.5% deaths not directly related to the injury and the exclusion of patients dead on arrival significantly affected the unadjusted mortality rate, ISS, median age and time to death.
authors.forename: Poya
authors.initials: P
authors.lastname: Ghorbani
authors.forename: Magnus
authors.initials: M
authors.lastname: Falkén
authors.forename: Louis
authors.initials: L
authors.lastname: Riddez
authors.forename: Martin
authors.initials: M
authors.lastname: Sundelöf
authors.forename: Anders
authors.initials: A
authors.lastname: Oldner
authors.affiliation: Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden. Lovisa.Strommer@karolinska.se.
authors.forename: Lovisa
authors.initials: L
authors.lastname: Strömmer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006274:Health Facility Moving / Q000639:trends; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult