title: Epidemiology of in-hospital trauma deaths in a Brazilian university hospital.
abstract: BACKGROUND
  The analysis of patterns of trauma deaths may improve the evaluation of a trauma system and identify areas that may benefit from more resources. The objective of this study was to analyze the epidemiology of trauma deaths in a Brazilian university hospital in order to assess the profile of these fatalities over a 16-year period.
  
  
  METHODS
  Retrospective study of time series using database records. The research subjects were in-hospital deaths from external causes during the years 1995, 2000, 2005 and 2010. The following variables were analyzed: cause of injury, trauma scores, time and cause of death.
  
  
  RESULTS
  467 cases were studied, being 325 patients (69.6%) admitted with signs of life and 142 (30.4%) considered dead on arrival. The mean age was 35.35 ± 18.03 years. 85.4% were males. Blunt trauma occurred in 73.0% of cases and penetrating mechanism in 27.0%. There was a significant increase (p < 0.001) in deaths from motorcycle crashes over the years, which went from 7.3% in 1995 to 31.5% in 2010. In contrast, there was a significant decrease (p = 0.030) in firearm-injury victims; from 21.0% in 1995 to 9.6% in 2010. About 60% of deaths occurred less than 24 hours after admission. The main causes of death were lesions of the central nervous system (56.3% of the total), followed by hemorrhagic shock (18.1%) and sepsis/multiple organ dysfunction syndrome (17.1%). The mean Injury Severity Score (ISS) of patients with signs of life was 26.41 ± 9.00, 71.3% of whom had ISS >25. The mean Revised Trauma Score (RTS) was 5.24 ± 2.05. Only 25.8% of the deaths had TRISS <0.50.
  
  
  CONCLUSIONS
  There was a shift in the profile of causes of death from trauma in this university teaching hospital, with a large decrease in penetrating injuries and a higher incidence of deaths of motorcycle riders.
authors.affiliation: Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil. adrianotrajano@gmail.com.
authors.forename: Adriano D
authors.initials: AD
authors.lastname: Trajano
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Pereira
authors.forename: Gustavo P
authors.initials: GP
authors.lastname: Fraga
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009049:Motorcycles; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000209:etiology / Q000401:mortality*; D014950:Wounds, Penetrating / Q000209:etiology / Q000401:mortality*; D055815:Young Adult