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Bansal V, Fortlage D, Lee JG, et al. Hemorrhage is More Prevalent than Brain Injury in Early Trauma Deaths: The Golden Six Hours. Eur J Trauma Emerg Surg. 2008;35(1):26-30doi: 10.1007/s00068-008-8080-2.
Bansal, V., Fortlage, D., Lee, J. G., Costantini, T., Potenza, B., & Coimbra, R. (2009). Hemorrhage is More Prevalent than Brain Injury in Early Trauma Deaths: The Golden Six Hours. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 35(1), 26-30. https://doi.org/10.1007/s00068-008-8080-2
Bansal, Vishal, et al. "Hemorrhage is More Prevalent than Brain Injury in Early Trauma Deaths: The Golden Six Hours." European journal of trauma and emergency surgery : official publication of the European Trauma Society vol. 35,1 (2009): 26-30. doi: https://doi.org/10.1007/s00068-008-8080-2
Bansal V, Fortlage D, Lee JG, Costantini T, Potenza B, Coimbra R. Hemorrhage is More Prevalent than Brain Injury in Early Trauma Deaths: The Golden Six Hours. Eur J Trauma Emerg Surg. 2009 Feb;35(1):26-30. doi: 10.1007/s00068-008-8080-2. Epub 2008 Nov 26. PMID: 26814527.
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Eur J Trauma Emerg Surg. 2009 Feb;35(1):26-30. doi: 10.1007/s00068-008-8080-2. Epub 2008 Nov 26.

Hemorrhage is More Prevalent than Brain Injury in Early Trauma Deaths: The Golden Six Hours.

European journal of trauma and emergency surgery : official publication of the European Trauma Society

Vishal Bansal, Dale Fortlage, Jeanne G Lee, Todd Costantini, Bruce Potenza, Raul Coimbra

Affiliations

  1. Division of Trauma, Burns and Critical Care, Department of Surgery, University of California San Diego, San Diego, CA, USA. [email protected].
  2. Division of Trauma, Burns and Critical Care, Department of Surgery, University of California San Diego, 200 W Arbor Drive #8896, San Diego, CA, 92103, USA. [email protected].

PMID: 26814527 DOI: 10.1007/s00068-008-8080-2

Abstract

INTRODUCTION: Under the trimodal distribution, most trauma deaths occur within the first hour. Determination of cause of death without autopsy review is inaccurate. The goal of this study is to determine cause of death, in hourly intervals, in trauma patients who died in the first 24 h, as determined by autopsy.

MATERIALS AND METHODS: Trauma deaths that occurred within 24 h at a Level I trauma center were reviewed over a six-year period ending December 2005. Timing of death was separated into 0-1, 1-3, 3-6, 6-12 and 12-24 h intervals. Cause of death was determined by clinical course and AIS scores, and was confirmed by autopsy results.

RESULTS: Overall, 9,388 trauma patients were admitted, of which 185 deaths occurred within 24 h, with 167 available autopsies. Blunt and penetrating were the injury mechanisms in 122 (73%) and 45 (27%) patients, respectively. Of 167 deaths, 73 (43.7%) occurred within the first hour. Brain injury, when compared to other body areas, was the most likely cause of death in all hourly intervals, but hemorrhage was as or more important than brain injury as the cause of death during the first 3 h and up to 6 h. No deaths were attributable to hemorrhage after 12 h.

CONCLUSIONS: The temporal distribution of the cause of death varies in the first 24 h after admission. Hemorrhage should not be overlooked as the cause of death, even after survival beyond 1 h. Understanding the temporal relationship of causes of early death can aid in the targeting of management and surgical training to optimize patient outcome.

Keywords: Autopsy; Brain injury; Hemorrhage; Mortality; Trauma

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