title: Predictors of Death in Trauma Patients who are Alive on Arrival at Hospital.
abstract: OBJECTIVE
  To determine which factors predict death occurring in trauma patients who are alive on arrival at hospital Design Prospective cohort study Method Data were collected from 507 trauma patients with multiple injuries, with a Hospital Trauma Index-Injury Severity Score of 16 or more, who were initially delivered by the Emergency Medical Services to the Emergency Department of the University Medical Centre Utrecht (UMCU) during the period 1999-2000.
  
  
  RESULTS
  Univariate analysis showed that every year of age increase resulted in a 2% greater risk of death. If the patient had been intubated at the scene of the accident, this risk was increased 4.3-fold. Every point of increase in the Triage Revised Trauma Score (T-RTS) reduced the risk of death by 30%. A similar (but inverse) tendency was found for the HTI-ISS score, with every point of increase resulting in a 5% greater risk of death. There was a clear relationship between the base excess (BE) and hemoglobin (Hb) levels and the risk of death, the latter being increased by 8% for each mmol/l drop in BE, and reduced by 22% for each mmol/l increase in Hb. The risk of death occurring was 2.6 times higher in cases with isolated neurotrauma. These associations hardly changed in the multivariate analysis; only the relation with having been intubated at the scene disappeared.
  
  
  CONCLUSIONS
  The risk of severely injured accident patients dying after arriving in hospital is mainly determined by the T-RTS, age, presence of isolated neurological damage, BE and Hb level. Skull/brain damage and hemorrhage appear to be the most important causes of death in the first 24 h after the accident. The time interval between the accident and arrival at the hospital does not appear to affect the risk of death.
authors.affiliation: RAVU - EMS, Nassaustraat 127, Maarssen, Utrecht, 3601 BE, The Netherlands. LMMC@wxs.nl.|RAVU - EMS, Nassaustraat 127, Maarssen, Utrecht, 3601 BE, The Netherlands. LMMC@wxs.nl.
authors.forename: Rob A
authors.initials: RA
authors.lastname: Lichtveld
authors.affiliation: Department of Anaesthesiology, University Medical Centre St Radboud, Nijmegen, The Netherlands.
authors.forename: Ivo F
authors.initials: IF
authors.lastname: Panhuizen
authors.affiliation: Forensic Medicine, Municipal Health Authority, Amsterdam, The Netherlands.
authors.forename: Ronald B J
authors.initials: RB
authors.lastname: Smit
authors.affiliation: Rehabilitation Medicine, University Medical Centre St Radboud, Nijmegen, The Netherlands.
authors.forename: Hermann R
authors.initials: HR
authors.lastname: Holtslag
authors.affiliation: Department of Surgery, Universtiy Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Christian
authors.initials: C
authors.lastname: van der Werken
keywords: Multiple trauma; Polytrauma; Polytrauma managment including prehospital and shockroom; Scoring systems; Thorax and abdominal trauma; Trauma registries; Traumatic brain; injury