Pooled preventable death rates in trauma patients

Kwon, Annette; Garbett, N. C.; Kloecker, Goetz

doi:10.1007/s00068-013-0364-5

Cited by 44 publications

(27 citation statements)

References 31 publications

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“…Injury is the leading cause of death for US adults under the age of 45 1 . Approximately 20% of these trauma deaths are considered potentially preventable 2,3 . To address the public health burden from these preventable deaths, the National Academies of Sciences, Engineering, and Medicine recently published a report with recommendations to mitigate death from trauma 2 .…”

Section: Introductionmentioning

confidence: 99%

Patterns of Anatomic Injury in Critically Injured Combat Casualties: A Network Analysis

Janak

Mazuchowski

Kotwal

et al. 2019

Sci Rep

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A mortality review of death caused by injury requires a determination of injury survivability prior to a determination of death preventability. If injuries are nonsurvivable, only non-medical primary prevention strategies have potential to prevent the death. Therefore, objective measures are needed to empirically inform injury survivability from complex anatomic patterns of injury. As a component of injury mortality reviews, network structures show promise to objectively elucidate survivability from complex anatomic patterns of injury resulting from explosive and firearm mechanisms. In this network analysis of 5,703 critically injured combat casualties, patterns of injury among fatalities from explosive mechanisms were associated with both a higher number and severity of anatomic injuries to regions such as the extremities, abdomen, and thorax. Patterns of injuries from a firearm were more isolated to individual body regions with fatal patterns involving more severe injuries to the head and thorax. Each injury generates a specific level of risk as part of an overall anatomic pattern to inform injury survivability not always captured by traditional trauma scoring systems. Network models have potential to further elucidate differences between potentially survivable and nonsurvivable anatomic patterns of injury as part of the mortality review process relevant to improving both the military and civilian trauma care systems.

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Section: Introductionmentioning

confidence: 99%

Patterns of Anatomic Injury in Critically Injured Combat Casualties: A Network Analysis

Janak

Mazuchowski

Kotwal

et al. 2019

Sci Rep

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“…Although traumatic brain injury is the predominant source of mortality and morbidity, hemorrhage remains a common cause of preventable death in both adults and children. [3][4][5] Furthermore, trauma-induced coagulopathy is common, and is associated with poor outcomes in injured pediatric patients. [6][7][8] Injured children requiring massive transfusion have a greater than 50% mortality rate 9 and died at a rate 2 to 3 times greater than adult patients with traumatic injury.…”

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confidence: 99%

Low Titer Group O Whole Blood In Injured Children Requiring Massive Transfusion

et al. 2021

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Objective: The aim of this study was to assess the survival impact of low-titer group O whole blood (LTOWB) in injured pediatric patients who require massive transfusion. Summary Background Data: Limited data are available regarding the effectiveness of LTOWB in pediatric trauma. Methods: A prospective observational study of children requiring massive transfusion after injury at UPMC Children’s Hospital of Pittsburgh, an urban academic pediatric Level 1 trauma center. Injured children ages 1 to 17 years who received a total of >40 mL/kg of LTOWB and/or conventional components over the 24 hours after admission were included. Patient characteristics, blood product utilization and clinical outcomes were analyzed using Kaplan-Meier survival curves, log rank tests and Cox proportional hazards regression analyses. The primary outcome was 28-day survival. Results: Of patients analyzed, 27 of 80 (33%) received LTOWB as part of their hemostatic resuscitation. The LTOWB group was comparable to the component therapy group on baseline demographic and physiologic parameters except older age, higher body weight, and lower red blood cell and plasma transfusion volumes. After adjusting for age, total blood product volume transfused in 24 hours, admission base deficit, international normalized ratio (INR), and injury severity score (ISS), children who received LTOWB as part of their resuscitation had significantly improved survival at both 72 hours and 28 days post-trauma [adjusted odds ratio (AOR) 0.23, P = 0.009 and AOR 0.41, P = 0.02, respectively]; 6-hour survival was not statistically significant (AOR = 0.51, P = 0.30). Survivors at 28 days in the LTOWB group had reduced hospital LOS, ICU LOS, and ventilator days compared to the CT group. Conclusion: Administration of LTOWB during the hemostatic resuscitation of injured children requiring massive transfusion was independently associated with improved 72-hour and 28-day survival.

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“…3 Additionally, at least 20% of all trauma deaths are the result of survivable injuries and are therefore preventable with optimal care. 1,4 …”

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confidence: 99%

Earlier Endpoints are Required for Hemorrhagic Shock Trials Among Severely Injured Patients

Fox

Holcomb

Wade

et al. 2017

Shock

128

122

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Background Choosing the appropriate endpoint for a trauma hemorrhage control trial can determine the likelihood of its success. Recent Phase 3 trials and observational studies have used 24-hour and/or 30-day all-cause mortality as the primary endpoint and some have not used exception from informed consent (EFIC), resulting in multiple failed trials. Five recent high-quality prospective studies among 4,064 hemorrhaging trauma patients provide new evidence to support earlier primary endpoints. Methods The goal of this project was to determine the optimal endpoint for hemorrhage control trials using existing literature and new analyses of previously published data. Results Recent studies among bleeding trauma patients show that hemorrhagic deaths occur rapidly, at a high rate, and in a consistent pattern. Early preventable deaths among trauma patients are largely due to hemorrhage and the median time to hemorrhagic death from admission is 2.0-2.6 hours. Approximately 85% of hemorrhagic deaths occur within 6 hours. The hourly mortality rate due to traumatic injury decreases rapidly after enrollment from 4.6% per hour at 1 hour post-enrollment to 1% per hour at 6 hours to <0.1% per hour by 9 hours and thereafter. Early primary endpoints (within 6 hours) have critically important benefits for hemorrhage control trials, including being congruent with the median time to hemorrhagic death, biologic plausibility, and enabling the use of all-cause mortality, which is definitive and objective. Conclusions Primary endpoints should be congruent with the timing of the disease process. Therefore, if a resuscitation/hemorrhage control intervention is under study, a primary endpoint of all-cause mortality evaluated within the first 6 hours is appropriate. Before choosing the timing of the primary endpoint for a large multicenter trial, we recommend performing a Phase 2 trial under EFIC to better understand the effects of the hemorrhage control intervention and distribution of time to death. When early primary endpoints are used, patients should be monitored for multiple subsequent secondary safety endpoints, including 24 hour and 30 day all-cause mortality as well as the customary safety endpoints.

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Pooled preventable death rates in trauma patients

Cited by 44 publications

References 31 publications

Patterns of Anatomic Injury in Critically Injured Combat Casualties: A Network Analysis

Patterns of Anatomic Injury in Critically Injured Combat Casualties: A Network Analysis

Low Titer Group O Whole Blood In Injured Children Requiring Massive Transfusion

Earlier Endpoints are Required for Hemorrhagic Shock Trials Among Severely Injured Patients

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