title: Epidemiology of in-hospital trauma deaths.
abstract: OBJECTIVE
  About half of all trauma-related deaths occur after hospital admission. The present study tries to characterize trauma deaths according to the time of death, and, thereby, contributes to the discussion about factors considered as the cause of death.
  
  
  METHODS
  Data from two large European trauma registries (Trauma Registry of the German Society of Trauma Surgery, TR-DGU, and the Trauma Audit and Research Network, TARN) were analyzed in parallel. All hospital deaths with Injury Severity Score (ISS) > 9 documented between 2000 and 2010 were considered. Patients were categorized into five subgroups according to the time to death (0-6 h; 7-24 h; day 1-6; day 7-30; beyond day 30). Surviving patients from the same time period served as a control group.
  
  
  RESULTS
  In total, 6,685 and 6,867 non-survivors were included from the TR-DGU and TARN, respectively. The hospital mortality rate was between 15 and 17%. About half of all deaths occurred within the first 24 h after admission (TR-DGU: 54%; TARN: 45%). The earliest subgroup of trauma deaths showed the highest mean ISS and the highest rate of mass transfusions. Severe head injury was most frequently observed in the subgroup of day 1-6. Late deaths are associated with higher age and more complications (sepsis, multiple organ failure).
  
  
  CONCLUSIONS
  The time to death after severe trauma does not follow a trimodal distribution but shows a constantly decreasing incidence.
authors.affiliation: Institute for Research in Operative Medicine, University Witten/Herdecke, Ostmerheimer Str. 200, 51109, Cologne, Germany. rolf.lefering@uni-wh.de.
authors.forename: R
authors.initials: R
authors.lastname: Lefering
authors.affiliation: Department for Trauma Surgery and Orthopaedics, Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Paffrath
authors.affiliation: Trauma Audit and Research Network, Health Sciences Research Group, School of Community Based Medicine, Manchester Medical Academic Health Sciences Centre, University of Manchester, Salford Royal Hospital, Salford, UK.
authors.forename: O
authors.initials: O
authors.lastname: Bouamra
authors.affiliation: Emergency Medicine Academic Group, University of Leicester, Leicester, UK.
authors.forename: T J
authors.initials: TJ
authors.lastname: Coats
authors.affiliation: Trauma Audit and Research Network, Health Sciences Research Group, School of Community Based Medicine, Manchester Medical Academic Health Sciences Centre, University of Manchester, Salford Royal Hospital, Salford, UK.
authors.forename: M
authors.initials: M
authors.lastname: Woodford
authors.affiliation: Trauma Audit and Research Network, Health Sciences Research Group, School of Community Based Medicine, Manchester Medical Academic Health Sciences Centre, University of Manchester, Salford Royal Hospital, Salford, UK.
authors.forename: T
authors.initials: T
authors.lastname: Jenks
authors.affiliation: Department for Trauma Surgery and Orthopaedics, Cologne Merheim Medical Center, University Witten/Herdecke, Cologne, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Wafaisade
authors.affiliation: Akademie Unfallchirurgie (AUC) of the German Society for Trauma Surgery (DGU), Cologne, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Nienaber
authors.affiliation: Trauma Audit and Research Network, Health Sciences Research Group, School of Community Based Medicine, Manchester Medical Academic Health Sciences Centre, University of Manchester, Salford Royal Hospital, Salford, UK.
authors.forename: F
authors.initials: F
authors.lastname: Lecky
keywords: Cause of deaths; Mortality; Severe injuries; Trauma; Trauma registry
references.citation: J Trauma. 2006 Sep;61(3):701-10
references.pmid: 16967011
references.citation: J Am Coll Surg. 2009 Jul;209(1):75-81
references.pmid: 19651066
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: Eur J Trauma Emerg Surg. 2009 Feb;35(1):26-30
references.pmid: 26814527
references.citation: J Trauma. 1990 Nov;30(11):1356-65
references.pmid: 2231804
references.citation: Dtsch Arztebl Int. 2008 Mar;105(13):225-31
references.pmid: 19629200
references.citation: J Am Coll Surg. 2004 Jan;198(1):20-6
references.pmid: 14698307
references.citation: Injury. 2008 Sep;39(9):993-1000
references.pmid: 18656867
references.citation: World J Surg. 2010 Jan;34(1):158-63
references.pmid: 19882185
references.citation: Intensive Care Med. 1996 Jul;22(7):707-10
references.pmid: 8844239
references.citation: Eur Surg Res. 2007;39(6):372-9
references.pmid: 17690556
references.citation: Eur J Trauma Emerg Surg. 2009 Oct;35(5):437-47
references.pmid: 26815209
references.citation: J Trauma. 2010 Sep;69(3):620-6
references.pmid: 20093983