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Epidemiology of Prehospital and Hospital Traumatic Deaths from Life-Threatening Hemorrhage

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Damage Control Resuscitation

Abstract

The health burden of injury on our society is substantial, and injury remains the leading cause of death in the United States, accounting for 59% of deaths up to age 45. The majority of injury mortality occurs before hospital arrival, with 62% of civilian and 87% of military traumatic deaths reported to occur prehospital. The concept of analyzing mortality after injury along a chronologic access was introduced in Dr. Trunkey’s seminal work describing the trimodal distribution of trauma deaths in immediate, early, and late timeframes after injury. “Immediate” deaths after trauma occur within less than 1 hour and are best addressed through trauma system development that includes prevention and safety interventions. “Early” deaths are most commonly attributed to massive bleeding and severe central nervous system injuries; the interval between injury and bleeding control has been identified as the key factor in survival for this group of severely injured patients. Trauma system development and injury care has focused intensely on early resuscitation and control of bleeding, largely through increased emphasis on prehospital care and rapid transport to designated trauma centers. The “late” timeframe of death after injury corresponds to patients who die days or weeks after injury usually due to infection, multiple organ failure, or devastating brain injury. About one-fourth of trauma deaths may be potentially preventable. Interventions dedicated to advanced bleeding control and hemostatic resuscitation in the field early after injury in tactical and austere environments have the greatest potential to improve survival after injury.

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References

  1. Accidental death and disability: The Neglected Disease of Modern Society. Washington, DC; 1966.

    Google Scholar 

  2. Finkelstein E, Corso PS, Miller TR. The incidence and economic burden of injuries in the United States. Oxford. New York: Oxford University Press; 2006.

    Book  Google Scholar 

  3. Web-based Injury Statistics Query and Reporting System (WISQARS). 2015. 2015. at http://www.cdc.gov/injury/wisqars.

  4. Baker CC, Oppenheimer L, Stephens B, Lewis FR, Trunkey DD. Epidemiology of trauma deaths. Am J Surg. 1980;140:144–50.

    Article  CAS  Google Scholar 

  5. Gaston SR. “Accidental death and disability: the neglected disease of modern society”. A progress report. J Trauma. 1971;11:195–206.

    Article  CAS  Google Scholar 

  6. Shackford SR, Mackersie RC, Holbrook TL, et al. The epidemiology of traumatic death. A population-based analysis. Arch Surg. 1993;128:571–5.

    Article  CAS  Google Scholar 

  7. CDC. Quickstats: percentage of injury deaths for which death was pronounced outside the hospital. MMWR. 2008;57(41):1130.

    Google Scholar 

  8. Trunkey DD. Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am. 1983;249:28–35.

    Article  CAS  Google Scholar 

  9. Trunkey D, Lim R. Analaysis of 425 consecutive trauma fatalities. J Am Coll Emerg Phys. 1974;3:368–71.

    Article  Google Scholar 

  10. Sauaia A, Moore FA, Moore EE, et al. Epidemiology of trauma deaths: a reassessment. J Trauma. 1995;38:185–93.

    Article  CAS  Google Scholar 

  11. Meislin H, Criss EA, Judkins D, et al. Fatal trauma: the modal distribution of time to death is a function of patient demographics and regional resources. J Trauma. 1997;43:433–40.

    Article  CAS  Google Scholar 

  12. Demetriades D, Kimbrell B, Salim A, et al. Tr deaths in a mature urban trauma system: is “trimodal” distribution a valid concept? J Am Coll Surg. 2005;201:343–8.

    Article  Google Scholar 

  13. Valdez C, Sarani B, Young H, Amdur R, Dunne J, Chawla LS. Timing of death after traumatic injury--a contemporary assessment of the temporal distribution of death. J Surg Res. 2016;200:604–9.

    Article  Google Scholar 

  14. Stewart RM, Myers JG, Dent DL, et al. Seven hundred fifty-three consecutive deaths in a level I trauma center: the argument for injury prevention. J Trauma. 2003;54:66–70; discussion -1.

    Article  Google Scholar 

  15. Teixeira PG, Inaba K, Hadjizacharia P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma. 2007;63:1338–46; discussion 46-7.

    Article  Google Scholar 

  16. Kotwal RS, Howard JT, Orman JA, et al. The effect of a golden hour policy on the morbidity and mortality of combat casualties. JAMA Surg. 2016;151:15–24.

    Article  Google Scholar 

  17. McNicholl BP. The golden hour and prehospital trauma care. Injury. 1994;25:251–4.

    Article  CAS  PubMed  Google Scholar 

  18. Newgard CD, Schmicker RH, Hedges JR, et al. Emergency medical services intervals and survival in trauma: assessment of the “golden hour” in a North American prospective cohort. Ann Emerg Med. 2010;55:235–46 e4.

    Article  PubMed  Google Scholar 

  19. Cowley R. Maryland State Med J. 1975;45:37–45.

    Google Scholar 

  20. Eastridge BJ, Mabry RL, Seguin P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(6):S431–7.

    Article  Google Scholar 

  21. Eastridge BJ, Hardin M, Cantrell J, et al. Died of wounds on the battlefield: causation and implications for improving combat casualty care. J Trauma. 2011;71:S4–8.

    Article  Google Scholar 

  22. Acosta JA, Yang JC, Winchell RJ, et al. Lethal injuries and time to death in a level I trauma center. J Am Coll Surg. 1998;186:528–33.

    Article  CAS  Google Scholar 

  23. Davis JS, Satahoo SS, Butler FK, et al. An analysis of prehospital deaths: who can we save? J Trauma Acute Care Surg. 2014;77:213–8.

    Article  Google Scholar 

  24. Bellamy RF. The causes of death in conventional land warfare: implications for combat casualty care research. Mil Med. 1984;149:55–62.

    Article  CAS  Google Scholar 

  25. Butler FK Jr, Hagmann J, Butler EG. Tactical combat casualty care in special operations. Mil Med. 1996;161(Suppl):3–16.

    Article  Google Scholar 

  26. Jacobs L, Burns KJ. The Hartford consensus to improve survivability in mass casualty events: process to policy. Am J Disaster Med. 2014;9:67–71.

    Article  Google Scholar 

  27. Carmona RH. Public health education: the use of unique strategies to educate the public in the principles of the Hartford consensus. Bull Am Coll Surg. 2015;100:53–5.

    Google Scholar 

  28. Moore K. Stop the bleeding: the Hartford consensus. J Emerg Nurs. 2017;43:482–3.

    Article  Google Scholar 

  29. Jacobs LM. The Hartford consensus III: implementation of bleeding control. Conn Med. 2015;79:431–5.

    Google Scholar 

  30. Alarhayem A, Eastridge BJ. Junctional hemorrhage and prehospital time after injury: highlighting the need for novel strategies to control complex sources of hemorrhage and temporize survival to definitive care. Military health system research symposium. Washington, DC: UT Health San Antonio; 2016.

    Google Scholar 

  31. Alarhayem AQ, Myers JG, Dent D, et al. Time is the enemy: mortality in trauma patients with hemorrhage from torso injury occurs long before the “golden hour”. Am J Surg. 2016;212:1101–5.

    Article  CAS  Google Scholar 

  32. Borgman MA, Spinella PC, Perkins JG, et al. The ratio of blood products transfused affects mortality in patients receiving massive transfusions at a combat support hospital. J Trauma. 2007;63:805–13.

    Article  Google Scholar 

  33. Duchesne JC, Holcomb JB. Damage control resuscitation: addressing trauma-induced coagulopathy. Br J Hosp Med (Lond). 2009;70:22–5.

    Article  Google Scholar 

  34. Cotton BA, Gunter OL, Isbell J, et al. Damage control hematology: the impact of a trauma exsanguination protocol on survival and blood product utilization. J Trauma. 2008;64:1177–82; discussion 82-3.

    Article  Google Scholar 

  35. Holcomb JB, del Junco DJ, Fox EE, et al. The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013;148:127–36.

    Article  PubMed  Google Scholar 

  36. Holcomb JB, Fox EE, Wade CE, Group PS. The PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. J Trauma Acute Care Surg. 2013;75:S1–2.

    Article  PubMed  Google Scholar 

  37. Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313:471–82.

    Article  CAS  PubMed  Google Scholar 

  38. Fox EE, Holcomb JB, Wade CE, Bulger EM, Tilley BC, Group PS. Earlier endpoints are required for hemorrhagic shock trials among severely injured patients. Shock. 2017;47:567–73.

    Article  PubMed  Google Scholar 

  39. Champion HR, Lombardo LV, Wade CE, Kalin EJ, Lawnick MM, Holcomb JB. Time and place of death from automobile crashes: research endpoint implications. J Trauma Acute Care Surg. 2016;81(3):420–6.

    Article  Google Scholar 

  40. Apodaca A, Olson CM Jr, Bailey J, Butler F, Eastridge BJ, Kuncir E. Performance improvement evaluation of forward aeromedical evacuation platforms in Operation Enduring Freedom. J Trauma Acute Care Surg. 2013;75:S157–63.

    Article  Google Scholar 

  41. Kotwal RS, Scott LLF, Janak JC, et al. The effect of prehospital transport time, injury severity, and blood transfusion on survival of US military casualties in Iraq. J Trauma Acute Care Surg. 2018;85:S112–S21.

    Google Scholar 

  42. Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Association of prehospital blood product transfusion during medical evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA. 2017;318:1581–91.

    Article  PubMed  Google Scholar 

  43. Fisher AD, Miles EA, Cap AP, Strandenes G, Kane SF. Tactical damage control resuscitation. Mil Med. 2015;180:869–75.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Combat Support Agency, Defense Health Agency, San Antonio, TX, USA

    Stacy Shackelford

  2. Department of Surgery, UTHealth Science Center San Antonio, San Antonio, TX, USA

    Brian J. Eastridge

Authors
  1. Stacy Shackelford
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  2. Brian J. Eastridge
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Correspondence to Brian J. Eastridge .

Editor information

Editors and Affiliations

  1. School of Medicine, Washington University in St. Louis, St. Louis, MO, USA

    Philip C. Spinella

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Shackelford, S., Eastridge, B.J. (2020). Epidemiology of Prehospital and Hospital Traumatic Deaths from Life-Threatening Hemorrhage. In: Spinella, P. (eds) Damage Control Resuscitation. Springer, Cham. https://doi.org/10.1007/978-3-030-20820-2_2

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  • DOI: https://doi.org/10.1007/978-3-030-20820-2_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-20819-6

  • Online ISBN: 978-3-030-20820-2

  • eBook Packages: MedicineMedicine (R0)

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