Is the “Death Triad” a Casualty of Modern Damage Control Resuscitation

Smith, Alison; Hendrix, Vera; Shapiro, Max; Duchesne, Juan; Taghavi, Sharven; Schroll, Rebecca; Tatum, Danielle; Guidry, Chrissy

doi:10.1016/j.jss.2020.09.018

Cited by 4 publications

(2 citation statements)

References 15 publications

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“…Hypothermia is a contributor to the cycle known as the Lethal Trauma Triad in trauma (Figure 4). This is the combination of hypothermia, metabolic acidosis and coagulopathy (12)(13)(14)(15) that poses significant mortality to the trauma patient.…”

Section: Exposurementioning

confidence: 99%

Fifteen-minute consultation: A guide to the paediatric primary survey

Kavanagh

Wallace

Sloane

et al. 2022

Arch Dis Child Educ Pract Ed

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It’s 21:00 and you receive a stand-by call from the local ambulance service. Peter, a 9-year-old boy, was riding an electric scooter and has collided with a car. He has reduced consciousness, signs of shock and is hypoxic. How will you prepare your team? What are the possible injuries? Who will perform the primary survey? Injury is the leading cause of morbidity and mortality in the paediatric population accounting for approximately half of all attendances to paediatric emergency departments in the UK and Ireland. Major trauma can be distressing for patients, parents and physicians. Managing major trauma is challenging and it is vital to have a clear and organised approach. In this 15-minute guide we describe a structured approach to the primary survey that includes how to prepare before the child’s arrival, the suggested roles of team members and the key components of the primary survey. We discuss life-threatening injuries, the life-saving bundle and the principles of resuscitation, and the role of imaging in the initial assessment of the injured child.

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Section: Exposurementioning

confidence: 99%

Fifteen-minute consultation: A guide to the paediatric primary survey

Kavanagh

Wallace

Sloane

et al. 2022

Arch Dis Child Educ Pract Ed

View full text Add to dashboard Cite

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“…The death triad observed in trauma patients has been proven to be a strong predictor of mortality [ 1 , 2 , 3 , 4 ]. The mortality of trauma patients at 24 h increased with the addition of all three components of the death triad [ 5 ]. In patients with multiple traumas, the death triad predicted 24 h mortality in 96% of patients [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

From Death Triad to Death Tetrad—The Addition of a Hypotension Component to the Death Triad Improves Mortality Risk Stratification in Trauma Patients: A Retrospective Cohort Study

et al. 2022

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The death triad, including coagulopathy, hypothermia, and acidosis, is shown to be a strong predictor of mortality in trauma patients. We aimed to investigate whether the inclusion of hypotension, defined as systolic blood pressure (SBP) < 60 mmHg, as a fourth factor in the death triad would comprise a death tetrad to help stratify mortality risk in trauma patients. A total of 3361 adult trauma patients between 1 January 2009 and 31 December 2019 were allocated into groups to investigate whether hypotension matters in determining the mortality outcome of trauma patients who possess 1–3 death triad components compared to those without any component. Hypotension was added to the death tetrad, and the adjusted mortality outcome was compared among groups with 0–4 death tetrad components. Herein, we showed that SBP < 60 mmHg could be used to identify patients at risk of mortality among patients with one or two death triad components. Patients with one, two, and three death tetrad components had respective adjusted mortality rates of 3.69-, 10.10-, and 40.18-fold, determined by sex, age, and comorbidities. The mortality rate of trauma patients with all the four death tetrad components was 100%. The study suggested that hypotension, defined as an SBP < 60 mmHg, may act as a proper death tetrad component to stratify the mortality risk of trauma patients.

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