Southwestern Surgical CongressTime is the enemy: Mortality in trauma patients with hemorrhage from torso injury occurs long before the “golden hour”
Section snippets
Background
In 1966, the National Academy of Sciences (NAS) published “Accidental Death and Disability: The Neglected Disease of Modern Society” perceiving injury to be one of the most significant public health problems faced by our nation.1 At the same point in history, the surgical community was taking note of significant successes in trauma care on the battlefields of Vietnam such as advanced resuscitation practices and refined aeromedical evacuation capabilities.2 The timely coevolution of these
Methods
This was a retrospective study of 2,523,394 patient records derived from the National Trauma Data Bank Research Datasets (NTDB-RDS) 2012 to 2014. The NTDB is compiled annually from participating trauma centers nationwide and is the largest aggregation of U.S. trauma registry data.
Patients with torso injury were identified utilizing Abbreviated Injury Scale (AIS) for body regions 4 (Thorax) and 5 (Abdomen). Torso injury morphology was ascribed utilizing the six digit pre dot AIS code. Injury
Results
The mean age of our sample population was 37.4 years, median ISS was 14, 67.6% of the patients were male, and 73.3% of patients sustained blunt trauma. Motor vehicle collisions (MVC) accounted for 75.6% of blunt injuries, while firearm related injuries accounted for 55.2% of penetrating trauma.
The overall mortality in this analysis was 7.9% (3326/42,135); 7.4% (2371/32,077) with blunt mechanisms, 3.3% (143/4325) with stab wounds, and 14.2% (812/5733) with firearm injuries. Of the 3, 326
Discussion
The basic tenets of trauma care and trauma systems have highlighted the need for rapid transport of the trauma patient. Improving our ability to temporize or definitively control hemorrhage in a timely fashion before the onset of shock represents a perpetual major challenge in reducing trauma mortality.15
Mortality studies from conflicts in Iraq and Afghanistan by Eastridge et al. found non-compressible torso hemorrhage (NCTH) to account for the majority of potentially survivable deaths. The
Conclusion
In patients with high-grade torso injury, AIS grades ≥4, the degree anatomic disruption is often associated with significant hemorrhage. In our study, a precipitous rise in patient mortality was exhibited in this high-grade injury group at prehospital times <30 min. Our data highlight that the critical nature of prehospital time in patients with non-compressible torso hemorrhage. However, realizing that evacuation times <30 min may not be realistic, particularly in rural or austere
Funding source
None.
Financial disclosure
The authors have no relevant financial relationships or conflicts of interest in relation to the presentation or publication of this work.
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