title: Trends in 1029 trauma deaths at a level 1 trauma center: Impact of a bleeding control bundle of care.
abstract: BACKGROUND
  Over the last decade the age of trauma patients and injury mortality has increased. At the same time, many centers have implemented multiple interventions focused on improved hemorrhage control, effectively resulting in a bleeding control bundle of care. The objective of our study was to analyze the temporal distribution of trauma-related deaths, the factors that characterize that distribution and how those factors have changed over time at our urban level 1 trauma center.
  
  
  METHODS
  Records at an urban Level 1 trauma center were reviewed. Two time periods (2005-2006 and 2012-2013) were included in the analysis. Mortality rates were directly adjusted for age, gender and mechanism of injury. The Mann-Whitney and chi square tests were used to compare variables between periods, with significance set at 0.05.
  
  
  RESULTS
  7080 patients (498 deaths) were examined in 2005-2006, while 8767 patients (531 deaths) were reviewed in 2012-2013. The median age increased 6 years, with a similar increase in those who died. In patients that died, no differences by gender, race or ethnicity were observed. Fall-related deaths are now the leading cause of death. Traumatic brain injury (TBI) and hemorrhage accounted for >91% of all deaths. TBI (61%) and multiple organ failure or sepsis (6.2%) deaths were unchanged, while deaths associated with hemorrhage decreased from 36% to 25% (p<0.01). Across time periods, 26% of all deaths occurred within one hour of hospital arrival, while 59% occurred within 24h. Unadjusted mortality dropped from 7.0% to 6.1 (p=0.01) and in-hospital mortality dropped from 6.0% to 5.0% (p<0.01). Adjusted mortality dropped 24% from 7.6% (95% CI: 6.9-8.2) to 5.8% (95% CI: 5.3-6.3) and in-hospital mortality decreased 30% from 6.6% (95% CI: 6.0-7.2) to 4.7 (95% CI: 4.2-5.1).
  
  
  CONCLUSIONS
  Over the same time frame of this study, increases in trauma death across the globe have been reported. This single-site study demonstrated a significant reduction in mortality, attributable to decreased hemorrhagic death. It is possible that efforts focused on hemorrhage control interventions (a bleeding control bundle) resulted in this reduction. These changing factors provide guidance on future prevention and intervention efforts.
authors.affiliation: Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Blessing T
authors.initials: BT
authors.lastname: Oyeniyi
authors.affiliation: Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Fox
authors.affiliation: Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Scerbo
authors.affiliation: Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Tomasek
authors.affiliation: Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.affiliation: Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery, Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA. Electronic address: John.Holcomb@uth.tmc.edu.
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
mesh_terms: D000328:Adult; D000368:Aged; D004635:Emergency Medicine / Q000639:trends; D005260:Female; D006470:Hemorrhage / Q000401:mortality / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000401:mortality / Q000639:trends*; D006490:Hemostatics / Q000627:therapeutic use*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D011787:Quality of Health Care; D012189:Retrospective Studies; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D014193:Trauma Centers; D057772:Vascular System Injuries / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000628:therapy*
chemical_list: D006490:Hemostatics
keywords: Hemorrhage; Mortality; Temporal distribution; Trauma death