title: Mortality Patterns in Patients with Multiple Trauma: A Systematic Review of Autopsy Studies.
abstract: OBJECTIVE
  A high percentage (50%-60%) of trauma patients die due to their injuries prior to arrival at the hospital. Studies on preclinical mortality including post-mortem examinations are rare. In this review, we summarized the literature focusing on clinical and preclinical mortality and studies included post-mortem examinations.
  
  
  METHODS
  A literature search was conducted using PubMed/Medline database for relevant medical literature in English or German language published within the last four decades (1980-2015). The following MeSH search terms were used in different combinations: "multiple trauma", "epidemiology", "mortality ", "cause of death", and "autopsy". References from available studies were searched as well.
  
  
  RESULTS
  Marked differences in demographic parameters and injury severity between studies were identified. Moreover, the incidence of penetrating injuries has shown a wide range (between 4% and 38%). Both unimodal and bimodal concepts of trauma mortality have been favored. Studies have shown a wide variation in time intervals used to analyze the distribution of death. Thus, it is difficult to say which distribution is correct.
  
  
  CONCLUSIONS
  We have identified variable results indicating bimodal or unimodal death distribution. Further more stundardized studies in this field are needed. We would like to encourage investigators to choose the inclusion criteria more critically and to consider factors affecting the pattern of mortality.
authors.affiliation: Department of Orthopedics and Trauma Surgery, Aachen University Medical Center, Aachen, Germany.
authors.forename: Roman
authors.initials: R
authors.lastname: Pfeifer
authors.affiliation: Department of Orthopedics and Trauma Surgery, Aachen University Medical Center, Aachen, Germany.
authors.forename: Michel
authors.initials: M
authors.lastname: Teuben
authors.affiliation: Department of Orthopedics and Trauma Surgery, Aachen University Medical Center, Aachen, Germany.
authors.forename: Hagen
authors.initials: H
authors.lastname: Andruszkow
authors.affiliation: Department of Trauma and Orthopaedic Surgery, Salford Royal NHS Foundation Trust, Salford, England, United Kingdom.
authors.forename: Bilal M
authors.initials: BM
authors.lastname: Barkatali
authors.affiliation: Department of Orthopedics and Trauma Surgery, Aachen University Medical Center, Aachen, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
mesh_terms: D001344:Autopsy; D001930:Brain Injuries / Q000401:mortality*; D002423:Cause of Death; D006801:Humans; D009104:Multiple Trauma / Q000401:mortality*; D016019:Survival Analysis