Clinical review is essential to evaluate 30-day mortality after trauma
Clinical review is essential to evaluate 30-day mortality after trauma
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DOI：
10.1186/1757-7241-22-18
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发表时间：
2014-03-13
影响因子：
3.3
通讯作者：
Strommer, Lovisa
中科院分区：
文献类型：
--
作者：
Ghorbani, Poya;Falken, Magnus;Strommer, Lovisa
背景：确保高质量的死亡率统计需要对所有创伤死亡进行系统评估。我们检查了创伤患者在30天内死于与损伤无关的原因的比例，以及排除到达时死亡的患者对30天创伤死亡率的影响。我们还对2007-2011年间我科创伤中心收治的30天内死亡的患者的人口学特征、损伤特征、死亡原因和死亡时间进行了定义。方法：对所有患者的人口学特征、损伤特征、到达时的存活/死亡状态、死亡原因和死亡时间进行回顾。按致伤机制(穿透伤、钝挫伤、低能量钝挫伤)和死因(创伤性脑损伤、出血、器官功能不全和其他/不明原因)分析死亡原因。结果：7422例住院患者中确认死亡343例，其中36例(10.5%)死亡原因与伤情无关。患者的总体年龄为71岁，损伤严重程度评分(ISS)为29，死亡时间为24小时(均为中位数)。54名患者(17.6%)在到达时死亡。排除到达时死亡的患者降低了总体死亡率(P<；0.05)和ISS中位数(P<；0.05)，增加了中位年龄(P<；0.01)和死亡时间(P<；0.001)。损伤机制为穿透伤占7.5%，钝挫伤占56.0%，低能量钝挫伤占36.5%。脑外伤占58.6%，出血占16.3%，器官功能障碍占15.0%，其他/不明原因占10.1%。与穿透伤和钝伤后死亡的患者相比，低能量钝挫伤死亡的患者年龄更大，ISS更低，死亡时间更长(均P<；0.01)。结论：所有创伤死亡的临床回顾对于解释死亡率至关重要。30天创伤死亡率包括10.5%与创伤无直接关系的死亡，排除到达时死亡的患者显著影响未调整的死亡率、ISS、中位年龄和死亡时间。
Background: Securing high-quality mortality statistics requires systematic evaluation of all trauma deaths. We examined the proportion of trauma patients dying within 30 days from causes not related to the injury and the impact of exclusion of patients dead on arrival on 30-day trauma mortality. We also defined the demographics, injury characteristics, cause of death and time to death in patients admitted to our trauma center who died within 30 days, between 2007-2011.Methods: Demographics, injury characteristics, status alive/dead on arrival, cause of death and time to death of all patients were reviewed. Deaths were analyzed based on injury mechanism (penetrating, blunt trauma and low energy blunt trauma) and cause of death (traumatic brain injury (TBI), hemorrhage, organ dysfunction and other/unknown).Results: Of the 7422 admissions, 343 deaths were identified of which 36 (10.5%) involved causes not related to the injury. The overall age was 71 years, Injury Severity Score (ISS) 29 and time to death 24 hours (all medians). Fifty-four patients (17.6%) were dead on arrival. Exclusion of patients dead on arrival reduced the overall mortality rate (P < 0.05) and median ISS (P < 0.05) and increased median age (P < 0.01) and time to death (P < 0.001). Injury mechanism was penetrating trauma in 7.5%, blunt trauma in 56.0%, and low energy blunt trauma in 36.5%. TBI accounted for 58.6%; hemorrhage 16.3%, organ dysfunction 15.0%, and other/unknown for 10.1% of the deaths. Patients who died after low energy blunt trauma were older, had lower ISS and longer time to death compared to those who died after penetrating and blunt trauma (all P < 0.01).Conclusions: Clinical review of all trauma deaths was essential to interpret mortality. Thirty-day trauma mortality included 10.5% deaths not directly related to the injury and the exclusion of patients dead on arrival significantly affected the unadjusted mortality rate, ISS, median age and time to death.