Mortality Patterns in Patients with Multiple Trauma: A Systematic Review of Autopsy Studies

Abstract

PurposeA 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.MethodsA 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.ResultsMarked 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.ConclusionsWe 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.

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“…In this study, the highest rate of reported death (n = 64%) related to the neurological disorders' was started from the age of 50 to 100 years old. This is in agreement with previous publications that recommended an in-depth analysis for age, gender-specific mortality rates [17] and other factors that affecting the pattern of mortality [16]. In another publication the mortality rates related to the tumors of central nervous system reported to be increased within all age groups, most significantly in patients aged 70 years or older [18].…”

“…Chauny et al, in 2016 confirmed that special care may be required for patients with serious mechanism of injury, those display marks of neurologic worsening, and patients presenting with extreme anticoagulation or getting antiplatelet co-medication [15]. Pfeifer et al, in 2016 reported that around 50 to 60 % of trauma patients die due to their injuries prior to arrival at the hospital [16]. In this study, the highest rate of reported death (n = 64%) related to the neurological disorders' was started from the age of 50 to 100 years old.…”

TRIAGE : Management of the trauma patient

“…A systematic review published in 2016 summarizes trauma studies performed over 30 years, and identifies that brain injury, exsanguination, and a combination of brain injury and severe bleeding were the leading causes of death after trauma [93]. Bleeding has been shown to be the leading cause of preventable deaths among trauma patients [94].…”

Prehospital care is critical to improving outcomes after major trauma

“…The trimodal distribution of death following major trauma, consisting of immediate (within 1 h of injury), early (within hours of injury) and late (within several weeks of injury) deaths, has been replaced in mature trauma systems by a unimodal distribution. The majority of deaths occur in the first several hours after injury, predominantly from haemorrhage and brain injury. These observations highlight the need to focus on immediate postinjury care.…”