Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later.

BACKGROUND: We conducted a comprehensive analysis of the epidemiology of trauma deaths in our urban county during a one-year period a decade ago. In the interim we have implemented a statewide trauma system, initiated a number of injury-prevention programs, and have had a major public effort to reduce drug traffic and related gangs. Consequently, we have reassessed the regional trauma mortality to ascertain the impact of these measures and to search for new injury patterns.
METHODS: Trauma deaths occurring within our urban county from January 1 through December 31, 2002 were reviewed for mechanism, demographics, and cause of fatal injury; cases were identified using death certificates from the Colorado Department of Public Health. We compared these data to the trauma fatalities occurring during 1992.
RESULTS: During the 2002 study period, there were 420 injury-related deaths. Most of the patients were men (296 patients, 70%), with a mean age of 47.3 years (median age, 42 years). The three predominant mechanisms of fatal injury were transport-related (180 patients, 43%), intentional (99 patients, 24%), and falls (86 patients, 20%). Comparison between 1992 and 2002 showed significant increases in the percentage of transport-related and fall-related deaths, and a significant reduction in intentional fatal injuries. There was also a shift in the percentage of deaths occurring in the first 24 h to delayed times. The death rate per capita in Denver County declined from 0.081 in 1992 to 0.060 in 2002.
CONCLUSIONS: Along with a decrease in the per capita death rate, the major mechanisms of patient's deaths changed substantively over the decade 1992-2002; there was a shift from intentional injuries to transport-related deaths as the predominant etiology of trauma related deaths. Recognition of such injury patterns will direct future injury-prevention efforts and coordination of citywide trauma care.