Trauma Mortality in Mature Trauma Systems: Are We Doing Better? An Analysis of Trauma Mortality Patterns, 1997–2008

TLDR

Advances in trauma care such as damage‑control surgery, hemostatic resuscitation, and lung‑protective ventilation have been introduced, yet overall survival has not improved despite these innovations. The study aimed to evaluate injury severity, mortality, and preventability over a 12‑year period in a mature trauma system to determine the benefits of these improvements. Using the institutional trauma registry and quality‑management database, the authors linked patient demographics, hospital stay, time to death, predicted probability of survival, and peer‑reviewed in‑hospital deaths to analyze outcomes for all primary trauma admissions from 1996 to 2008. Performance benchmarked against predicted probability of survival improved, with overall mortality ranging 3–3.7% and slightly worsening overall, but survival for patients with ISS 17–25 improved markedly; TBI accounted for 51.6% of deaths, hemorrhage 30%, and multiple organ failure 10.5%, with median times to death of 2 h, 24 h, and 15 days respectively, and these patterns remained stable over time.

Abstract

Advances in care such as damage control surgery, hemostatic resuscitation, protocol-driven cerebral perfusion management, and lung-protective ventilation have promised to improve survival after major trauma. We examined injury severity, mortality, and preventability in a mature trauma system during a 12-year period to assess the overall benefits of these and other improvements.Using the institutional trauma registry and the quality management database, we analyzed the outcome and the cause of death for all primary trauma admissions from July 1, 1996, to June 30, 2008, and linked these data with patient demographics, hospital length of stay, time to death, predicted probability of survival, and peer review of in-hospital deaths.Through fiscal year (FY) 2007, primary trauma admissions increased in number, injury severity, and age. Performance benchmarked against predicted probability of survival improved. Mortality through this era ranged from 3% to 3.7% and worsened slightly overall (p = 0.04). However, among those patients admitted with Injury Severity Score 17-25, survival improved significantly (p = 0.0003). Traumatic brain injury (TBI) accounted for 51.6% of deaths; acute hemorrhage, 30%; and multiple organ failure, 10.5%. Median time to death for uncontrollable hemorrhage, TBI, multiple organ failure was 2 hours, 24 hours, and 15 days, respectively. These patterns did not change significantly over time.Survival after severe trauma and survival benchmarked against predicted risk improved significantly at our center during the past 12 years despite generally increasing age and worsening injuries. Advances in trauma care have kept pace with an aging population and greater severity of injury, but overall survival has not improved.