title: Mortality Distribution in a Trauma System: From Data to Health Policy Recommendations.
abstract: BACKGROUND
  Trimodal distribution of deaths and the golden hour concepts are in part responsible for the genesis of all modern trauma systems but these concepts have been challenged recently. Our aim was to describe distribution of death in trauma using data from a trauma system and discuss what could be done from the organizational point of view to improve outcome.
  
  
  METHODS
  We included all traumatic deaths occurring between 2001 and 2005 in a trauma system. Data on age, gender, time and place of injury, time of first and second hospital arrival, cause of trauma and type of accident, hospital characteristics, dominant injury and time of death were collected for this study. Formortality distribution the variable time was transformed applying a natural logarithm.
  
  
  RESULTS
  A total of 1,436 deaths occurred over a period of 53 months; 52% at the scene, 18% in the level I trauma center, 21% in level III trauma center and the remaining in level IV/V trauma center. Death distribution using a logarithmic scale in minutes showed four peaks: deaths at the scene, deaths in the first hours, deaths in the first 2 days and finally, deaths in the second week that we referred as 2 min, 2 h, 2 days and 2 weeks peak. We found statistically significant differences in age and dominant injury concerning timing of death.
  
  
  CONCLUSIONS
  A tetramodal pattern of death distribution could be described. Our data support the need to focus on the treatment of severe head injuries namely in the intensive care environment.
authors.affiliation: Unidade de Cuidados Intensivos Polivalente, Hospital Geral de Santo António, Porto, Portugal. gomes.ernestina@gmail.com.|Unidade de Cuidados Intensivos Polivalente, Hospital Geral de Santo António, 4099-001, Porto, Portugal. gomes.ernestina@gmail.com.
authors.forename: Ernestina
authors.initials: E
authors.lastname: Gomes
authors.affiliation: Unidade de Cuidados Intensivos Polivalente, Hospital Geral de Santo António, Porto, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Araújo
authors.affiliation: Unidade de Cuidados Intensivos Polivalente, Hospital Geral de Santo António, Porto, Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Carneiro
authors.affiliation: Serviço de Bioestatística e Informática Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
authors.forename: Cláudia
authors.initials: C
authors.lastname: Dias
authors.affiliation: Trauma Audit and Research Network, University of Manchester, Hope Hospital, Salford, UK.
authors.forename: Fiona E
authors.initials: FE
authors.lastname: Lecky
authors.affiliation: Centro de Investigação em Tecnologias da Saúde e Sistemas de Informação em Saúde - CINTESIS, Serviço de Bioestatística e Informática Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
authors.forename: Altamiro
authors.initials: A
authors.lastname: Costa-Pereira
keywords: Epidemiology; Mortality distribution; Trauma; Trauma system
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