title: Hemorrhage is More Prevalent than Brain Injury in Early Trauma Deaths: The Golden Six Hours.
abstract: BACKGROUND
  Under the trimodal distribution, most trauma deaths occur within the first hour. Determination of cause of death without autopsy review is inaccurate. The goal of this study is to determine cause of death, in hourly intervals, in trauma patients who died in the first 24 h, as determined by autopsy.
  
  
  METHODS
  Trauma deaths that occurred within 24 h at a Level I trauma center were reviewed over a six-year period ending December 2005. Timing of death was separated into 0-1, 1-3, 3-6, 6-12 and 12-24 h intervals. Cause of death was determined by clinical course and AIS scores, and was confirmed by autopsy results.
  
  
  RESULTS
  Overall, 9,388 trauma patients were admitted, of which 185 deaths occurred within 24 h, with 167 available autopsies. Blunt and penetrating were the injury mechanisms in 122 (73%) and 45 (27%) patients, respectively. Of 167 deaths, 73 (43.7%) occurred within the first hour. Brain injury, when compared to other body areas, was the most likely cause of death in all hourly intervals, but hemorrhage was as or more important than brain injury as the cause of death during the first 3 h and up to 6 h. No deaths were attributable to hemorrhage after 12 h.
  
  
  CONCLUSIONS
  The temporal distribution of the cause of death varies in the first 24 h after admission. Hemorrhage should not be overlooked as the cause of death, even after survival beyond 1 h. Understanding the temporal relationship of causes of early death can aid in the targeting of management and surgical training to optimize patient outcome.
authors.forename: Vishal
authors.initials: V
authors.lastname: Bansal
authors.forename: Dale
authors.initials: D
authors.lastname: Fortlage
authors.forename: Jeanne G
authors.initials: JG
authors.lastname: Lee
authors.forename: Todd
authors.initials: T
authors.lastname: Costantini
authors.forename: Bruce
authors.initials: B
authors.lastname: Potenza
authors.affiliation: Division of Trauma, Burns and Critical Care, Department of Surgery, University of California San Diego, San Diego, CA, USA. rcoimbra@ucsd.edu.|Division of Trauma, Burns and Critical Care, Department of Surgery, University of California San Diego, 200 W Arbor Drive #8896, San Diego, CA, 92103, USA. rcoimbra@ucsd.edu.
authors.forename: Raul
authors.initials: R
authors.lastname: Coimbra
keywords: Autopsy; Brain injury; Hemorrhage; Mortality; Trauma
references.citation: J Am Coll Surg. 2005 Sep;201(3):343-8
references.pmid: 16125066
references.citation: Sci Am. 1983 Aug;249(2):28-35
references.pmid: 6623052
references.citation: J Trauma. 1995 Feb;38(2):185-93
references.pmid: 7869433
references.citation: J Neurotrauma. 2007;24 Suppl 1:S1-106
references.pmid: 17511534
references.citation: J Am Coll Surg. 2004 Jan;198(1):20-6
references.pmid: 14698307
references.citation: J Emerg Med. 2007 Oct;33(3):265-71
references.pmid: 17976554
references.citation: Am J Surg. 2007 Feb;193(2):195-9
references.pmid: 17236846
references.citation: Can J Surg. 2000 Apr;43(2):130-6
references.pmid: 10812348
references.citation: J Trauma. 1997 Sep;43(3):433-40
references.pmid: 9314304
references.citation: J Am Coll Surg. 2006 Jul;203(1):30-43
references.pmid: 16798485
references.citation: J Trauma. 2003 Jan;54(1):66-70; discussion 70-1
references.pmid: 12544901
references.citation: Arch Surg. 1993 May;128(5):571-5
references.pmid: 8489391
references.citation: J Am Coll Surg. 1998 May;186(5):528-33
references.pmid: 9583692
references.citation: AJR Am J Roentgenol. 2007 Feb;188(2):415-21
references.pmid: 17242250