BACKGROUND: With the advent of trauma systems, time to definitive care has been decreased. We hypothesized that a subset of patients who are in extremis from the time of prehospital transport to arrival at the trauma center, and who ultimately die early after arrival, may in fact have a potentially salvageable single-organ injury. METHODS: We reviewed all deaths that occurred in the first hour after hospital admission. Trauma registry, medical records, and autopsy reports for 556 patients were evaluated. RESULTS: The median time to arrival was 39 minutes, and the median Injury Severity Score was 29. Blunt injuries (53%) were most commonly auto-accident injuries (134 of 285 patients; 47%). Penetrating wounds (42%) were mostly gunshot wounds to the chest (73 of 233 patients; 31%). For patients with initial vital signs, the most common cause of death was isolated brain injury (26 patients; 28%). Possibly survivable injuries (single organ or vessel) occurred in 35 (38%) patients, of which 4 were isolated spleen injuries (4%). CONCLUSIONS: Some patients with potentially survivable single organ injuries did not have associated head injuries. An aggressive approach is warranted on patients with detectable vital signs on at least one occasion in the field but who arrive at the trauma center in extremis.
BACKGROUND: With the advent of trauma systems, time to definitive care has been decreased. We hypothesized that a subset of patients who are in extremis from the time of prehospital transport to arrival at the trauma center, and who ultimately die early after arrival, may in fact have a potentially salvageable single-organ injury. METHODS: We reviewed all deaths that occurred in the first hour after hospital admission. Trauma registry, medical records, and autopsy reports for 556 patients were evaluated. RESULTS: The median time to arrival was 39 minutes, and the median Injury Severity Score was 29. Blunt injuries (53%) were most commonly auto-accident injuries (134 of 285 patients; 47%). Penetrating wounds (42%) were mostly gunshot wounds to the chest (73 of 233 patients; 31%). For patients with initial vital signs, the most common cause of death was isolated brain injury (26 patients; 28%). Possibly survivable injuries (single organ or vessel) occurred in 35 (38%) patients, of which 4 were isolated spleen injuries (4%). CONCLUSIONS: Some patients with potentially survivable single organ injuries did not have associated head injuries. An aggressive approach is warranted on patients with detectable vital signs on at least one occasion in the field but who arrive at the trauma center in extremis.
Authors: Roman Pfeifer; Sylvia Schick; Christopher Holzmann; Matthias Graw; Michel Teuben; Hans-Christoph Pape Journal: World J Surg Date: 2017-12 Impact factor: 3.352
Authors: Christian Kleber; Moritz T Giesecke; Michael Tsokos; Norbert P Haas; Klaus D Schaser; Poloczek Stefan; Claas T Buschmann Journal: World J Surg Date: 2012-09 Impact factor: 3.352
Authors: Martin A Schreiber; Eric N Meier; Samuel A Tisherman; Jeffrey D Kerby; Craig D Newgard; Karen Brasel; Debra Egan; William Witham; Carolyn Williams; Mohamud Daya; Jeff Beeson; Belinda H McCully; Stephen Wheeler; Delores Kannas; Susanne May; Barbara McKnight; David B Hoyt Journal: J Trauma Acute Care Surg Date: 2015-04 Impact factor: 3.313
Authors: Marc Maegele; Thomas Brockamp; Ulrike Nienaber; Christian Probst; Herbert Schoechl; Klaus Görlinger; Philip Spinella Journal: Transfus Med Hemother Date: 2012-03-08 Impact factor: 3.747
Authors: Mohammad A Khasawneh; Martin D Zielinski; Donald H Jenkins; Scott P Zietlow; Henry J Schiller; Mariela Rivera Journal: World J Surg Date: 2014-08 Impact factor: 3.352
Authors: Philip H Pucher; Rajesh Aggarwal; Ahmed Twaij; Nicola Batrick; Michael Jenkins; Ara Darzi Journal: World J Surg Date: 2013-04 Impact factor: 3.352