title: Cause of death and time of death distribution of trauma patients in a Level I trauma centre in the Netherlands.
abstract: OBJECTIVE
  The classical trimodal distribution of trauma deaths describes three peaks of deaths following trauma: immediate, early and late deaths. The aim of this study was to evaluate whether further maturation of the trauma centre and the improvement of survival have had an effect on the time of death distribution and resulted in a shift in causes of death.
  
  
  METHODS
  All trauma patients from 1999 to 2010 who died after arrival in the emergency room and prior to discharge from the hospital were included. Deaths caused by drowning, poisoning and overdose were excluded.
  
  
  RESULTS
  A total of 16,421 trauma patients were admitted to our hospital. 772 (4.7 %) patients died, of which 720 were included in this study. The trauma mechanism was predominantly blunt (94.7 %). 530 patients (73.6 %) had Injury Severity Score (ISS) ≥25. The most frequent causes of death were central nervous system (CNS) injury (59.9 %), exsanguinations (12.9 %) and pneumonia/respiratory insufficiency (8.5 %). The first peak of death was seen in the first hour after arrival at the emergency department; subsequently, a rapid decline was observed and no further peaks were seen. Over the years, we observed a general decrease in deaths due to exsanguination (p = 0.035) and a general increase in deaths due to CNS injury (p = 0.004).
  
  
  CONCLUSIONS
  The temporal distribution of trauma deaths in our hospital changed as maturation of the trauma centre occurred. There is one peak of trauma deaths in the first hour after admission, followed by a rapid decline; no trimodal distribution was observed. Over time, there was a decrease in exsanguinations and an increase of deaths due to CNS injury.
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Suite G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. k.w.w.lansink@umcutrecht.nl.
authors.forename: K W W
authors.initials: KW
authors.lastname: Lansink
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Suite G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Gunning
authors.affiliation: Department of Surgery, University Medical Center Utrecht, Suite G04.228, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
authors.forename: L P H
authors.initials: LP
authors.lastname: Leenen
keywords: Cause of deaths; Mortality; Outcome; Trauma; Trauma deaths; Trimodal distribution
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