The why and how our trauma patients die: A prospective Multicenter Western Trauma Association study

Western Trauma Association Multicenter Study Group

Research output: Contribution to journalArticle

Abstract

BACKGROUND Historically, hemorrhage has been attributed as the leading cause (40%) of early death. However, a rigorous, real-time classification of the cause of death (COD) has not been performed. This study sought to prospectively adjudicate and classify COD to determine the epidemiology of trauma mortality. METHODS Eighteen trauma centers prospectively enrolled all adult trauma patients at the time of death during December 2015 to August 2017. Immediately following death, attending providers adjudicated the primary and contributing secondary COD using standardized definitions. Data were confirmed by autopsies, if performed. RESULTS One thousand five hundred thirty-six patients were enrolled with a median age of 55 years (interquartile range, 32-75 years), 74.5% were male. Penetrating mechanism (n = 412) patients were younger (32 vs. 64, p < 0.0001) and more likely to be male (86.7% vs. 69.9%, p < 0.0001). Falls were the most common mechanism of injury (26.6%), with gunshot wounds second (24.3%). The most common overall primary COD was traumatic brain injury (TBI) (45%), followed by exsanguination (23%). Traumatic brain injury was nonsurvivable in 82.2% of cases. Blunt patients were more likely to have TBI (47.8% vs. 37.4%, p < 0.0001) and penetrating patients exsanguination (51.7% vs. 12.5%, p < 0.0001) as the primary COD. Exsanguination was the predominant prehospital (44.7%) and early COD (39.1%) with TBI as the most common later. Penetrating mechanism patients died earlier with 80.1% on day 0 (vs. 38.5%, p < 0.0001). Most deaths were deemed disease-related (69.3%), rather than by limitation of further aggressive care (30.7%). Hemorrhage was a contributing cause to 38.8% of deaths that occurred due to withdrawal of care. CONCLUSION Exsanguination remains the predominant early primary COD with TBI accounting for most deaths at later time points. Timing and primary COD vary significantly by mechanism. Contemporaneous adjudication of COD is essential to elucidate the true understanding of patient outcome, center performance, and future research.

Original languageEnglish (US)
Pages (from-to)864-870
Number of pages7
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number5
DOIs
StatePublished - May 1 2019
Externally publishedYes

Fingerprint

Cause of Death
Exsanguination
Wounds and Injuries
Hemorrhage
Gunshot Wounds
Trauma Centers
Autopsy
Epidemiology
Traumatic Brain Injury
Mortality

Keywords

  • cause of death
  • exsanguination
  • Hemorrhage

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

The why and how our trauma patients die : A prospective Multicenter Western Trauma Association study. / Western Trauma Association Multicenter Study Group.

In: Journal of Trauma and Acute Care Surgery, Vol. 86, No. 5, 01.05.2019, p. 864-870.

Research output: Contribution to journalArticle

Western Trauma Association Multicenter Study Group. / The why and how our trauma patients die : A prospective Multicenter Western Trauma Association study. In: Journal of Trauma and Acute Care Surgery. 2019 ; Vol. 86, No. 5. pp. 864-870.
@article{d9a55309e98d41e9be1ebf8e359da85e,
title = "The why and how our trauma patients die: A prospective Multicenter Western Trauma Association study",
abstract = "BACKGROUND Historically, hemorrhage has been attributed as the leading cause (40{\%}) of early death. However, a rigorous, real-time classification of the cause of death (COD) has not been performed. This study sought to prospectively adjudicate and classify COD to determine the epidemiology of trauma mortality. METHODS Eighteen trauma centers prospectively enrolled all adult trauma patients at the time of death during December 2015 to August 2017. Immediately following death, attending providers adjudicated the primary and contributing secondary COD using standardized definitions. Data were confirmed by autopsies, if performed. RESULTS One thousand five hundred thirty-six patients were enrolled with a median age of 55 years (interquartile range, 32-75 years), 74.5{\%} were male. Penetrating mechanism (n = 412) patients were younger (32 vs. 64, p < 0.0001) and more likely to be male (86.7{\%} vs. 69.9{\%}, p < 0.0001). Falls were the most common mechanism of injury (26.6{\%}), with gunshot wounds second (24.3{\%}). The most common overall primary COD was traumatic brain injury (TBI) (45{\%}), followed by exsanguination (23{\%}). Traumatic brain injury was nonsurvivable in 82.2{\%} of cases. Blunt patients were more likely to have TBI (47.8{\%} vs. 37.4{\%}, p < 0.0001) and penetrating patients exsanguination (51.7{\%} vs. 12.5{\%}, p < 0.0001) as the primary COD. Exsanguination was the predominant prehospital (44.7{\%}) and early COD (39.1{\%}) with TBI as the most common later. Penetrating mechanism patients died earlier with 80.1{\%} on day 0 (vs. 38.5{\%}, p < 0.0001). Most deaths were deemed disease-related (69.3{\%}), rather than by limitation of further aggressive care (30.7{\%}). Hemorrhage was a contributing cause to 38.8{\%} of deaths that occurred due to withdrawal of care. CONCLUSION Exsanguination remains the predominant early primary COD with TBI accounting for most deaths at later time points. Timing and primary COD vary significantly by mechanism. Contemporaneous adjudication of COD is essential to elucidate the true understanding of patient outcome, center performance, and future research.",
keywords = "cause of death, exsanguination, Hemorrhage",
author = "{Western Trauma Association Multicenter Study Group} and Callcut, {Rachael A.} and Kornblith, {Lucy Z.} and Conroy, {Amanda S.} and Robles, {Anamaria J.} and Meizoso, {Jonathan P.} and Nicholas Namias and Meyer, {David E.} and Amanda Haymaker and Truitt, {Michael S.} and Vaidehi Agrawal and Haan, {James M.} and Lightwine, {Kelly L.} and Porter, {John M.} and {San Roman}, {Janika L.} and Biffl, {Walter L.} and Hayashi, {Michael S.} and Sise, {Michael J.} and Jayraan Badiee and Gustavo Recinos and Kenji Inaba and Schroeppel, {Thomas J.} and Emma Callaghan and Dunn, {Julie A.} and Samuel Godin and McIntyre, {Robert C.} and Peltz, {Erik D.} and O'Neill, {Patrick J.} and Diven, {Conrad F.} and Scifres, {Aaron M.} and Switzer, {Emily E.} and West, {Michaela A.} and Sarah Storrs and Cullinane, {Daniel C.} and Cordova, {John F.} and Moore, {Ernest E.} and Moore, {Hunter B.} and Privette, {Alicia R.} and Eriksson, {Evert A.} and Cohen, {Mitchell Jay}",
year = "2019",
month = "5",
day = "1",
doi = "10.1097/TA.0000000000002205",
language = "English (US)",
volume = "86",
pages = "864--870",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - The why and how our trauma patients die

T2 - A prospective Multicenter Western Trauma Association study

AU - Western Trauma Association Multicenter Study Group

AU - Callcut, Rachael A.

AU - Kornblith, Lucy Z.

AU - Conroy, Amanda S.

AU - Robles, Anamaria J.

AU - Meizoso, Jonathan P.

AU - Namias, Nicholas

AU - Meyer, David E.

AU - Haymaker, Amanda

AU - Truitt, Michael S.

AU - Agrawal, Vaidehi

AU - Haan, James M.

AU - Lightwine, Kelly L.

AU - Porter, John M.

AU - San Roman, Janika L.

AU - Biffl, Walter L.

AU - Hayashi, Michael S.

AU - Sise, Michael J.

AU - Badiee, Jayraan

AU - Recinos, Gustavo

AU - Inaba, Kenji

AU - Schroeppel, Thomas J.

AU - Callaghan, Emma

AU - Dunn, Julie A.

AU - Godin, Samuel

AU - McIntyre, Robert C.

AU - Peltz, Erik D.

AU - O'Neill, Patrick J.

AU - Diven, Conrad F.

AU - Scifres, Aaron M.

AU - Switzer, Emily E.

AU - West, Michaela A.

AU - Storrs, Sarah

AU - Cullinane, Daniel C.

AU - Cordova, John F.

AU - Moore, Ernest E.

AU - Moore, Hunter B.

AU - Privette, Alicia R.

AU - Eriksson, Evert A.

AU - Cohen, Mitchell Jay

PY - 2019/5/1

Y1 - 2019/5/1

N2 - BACKGROUND Historically, hemorrhage has been attributed as the leading cause (40%) of early death. However, a rigorous, real-time classification of the cause of death (COD) has not been performed. This study sought to prospectively adjudicate and classify COD to determine the epidemiology of trauma mortality. METHODS Eighteen trauma centers prospectively enrolled all adult trauma patients at the time of death during December 2015 to August 2017. Immediately following death, attending providers adjudicated the primary and contributing secondary COD using standardized definitions. Data were confirmed by autopsies, if performed. RESULTS One thousand five hundred thirty-six patients were enrolled with a median age of 55 years (interquartile range, 32-75 years), 74.5% were male. Penetrating mechanism (n = 412) patients were younger (32 vs. 64, p < 0.0001) and more likely to be male (86.7% vs. 69.9%, p < 0.0001). Falls were the most common mechanism of injury (26.6%), with gunshot wounds second (24.3%). The most common overall primary COD was traumatic brain injury (TBI) (45%), followed by exsanguination (23%). Traumatic brain injury was nonsurvivable in 82.2% of cases. Blunt patients were more likely to have TBI (47.8% vs. 37.4%, p < 0.0001) and penetrating patients exsanguination (51.7% vs. 12.5%, p < 0.0001) as the primary COD. Exsanguination was the predominant prehospital (44.7%) and early COD (39.1%) with TBI as the most common later. Penetrating mechanism patients died earlier with 80.1% on day 0 (vs. 38.5%, p < 0.0001). Most deaths were deemed disease-related (69.3%), rather than by limitation of further aggressive care (30.7%). Hemorrhage was a contributing cause to 38.8% of deaths that occurred due to withdrawal of care. CONCLUSION Exsanguination remains the predominant early primary COD with TBI accounting for most deaths at later time points. Timing and primary COD vary significantly by mechanism. Contemporaneous adjudication of COD is essential to elucidate the true understanding of patient outcome, center performance, and future research.

AB - BACKGROUND Historically, hemorrhage has been attributed as the leading cause (40%) of early death. However, a rigorous, real-time classification of the cause of death (COD) has not been performed. This study sought to prospectively adjudicate and classify COD to determine the epidemiology of trauma mortality. METHODS Eighteen trauma centers prospectively enrolled all adult trauma patients at the time of death during December 2015 to August 2017. Immediately following death, attending providers adjudicated the primary and contributing secondary COD using standardized definitions. Data were confirmed by autopsies, if performed. RESULTS One thousand five hundred thirty-six patients were enrolled with a median age of 55 years (interquartile range, 32-75 years), 74.5% were male. Penetrating mechanism (n = 412) patients were younger (32 vs. 64, p < 0.0001) and more likely to be male (86.7% vs. 69.9%, p < 0.0001). Falls were the most common mechanism of injury (26.6%), with gunshot wounds second (24.3%). The most common overall primary COD was traumatic brain injury (TBI) (45%), followed by exsanguination (23%). Traumatic brain injury was nonsurvivable in 82.2% of cases. Blunt patients were more likely to have TBI (47.8% vs. 37.4%, p < 0.0001) and penetrating patients exsanguination (51.7% vs. 12.5%, p < 0.0001) as the primary COD. Exsanguination was the predominant prehospital (44.7%) and early COD (39.1%) with TBI as the most common later. Penetrating mechanism patients died earlier with 80.1% on day 0 (vs. 38.5%, p < 0.0001). Most deaths were deemed disease-related (69.3%), rather than by limitation of further aggressive care (30.7%). Hemorrhage was a contributing cause to 38.8% of deaths that occurred due to withdrawal of care. CONCLUSION Exsanguination remains the predominant early primary COD with TBI accounting for most deaths at later time points. Timing and primary COD vary significantly by mechanism. Contemporaneous adjudication of COD is essential to elucidate the true understanding of patient outcome, center performance, and future research.

KW - cause of death

KW - exsanguination

KW - Hemorrhage

UR - http://www.scopus.com/inward/record.url?scp=85065069133&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85065069133&partnerID=8YFLogxK

U2 - 10.1097/TA.0000000000002205

DO - 10.1097/TA.0000000000002205

M3 - Article

C2 - 30633095

AN - SCOPUS:85065069133

VL - 86

SP - 864

EP - 870

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 5

ER -