Abstract
Hemorrhage is the major cause of early, preventable trauma deaths. We provide a contemporary(2018-2021) description of deaths of patients at risk for lethal traumatic hemorrhage admitted to seven trauma centers equipped with the most advanced hemostatic therapies.
This is a secondary analysis of non-survivors of the multicenter SWAT study, which enrolled patients at high-risk for life-threatening hemorrhage(age>15yrs, required blood+surgical/embolization hemorrhage control procedures<1 hour; penetrating head injury and >5min CPR were excluded. Causes of death(COD) were prospectively adjudicated by the SWAT team of trauma surgeons.
Of 1051 patients, 176(16.7%) died(74%<24hours,56%<6hours,35%<3hours). Bleeding was the main COD, occurring mostly <3hours. Over one third of these patients had a TRISS estimated survival probability>50%. . TBI was the COD in 10% of the deaths(TRISS=8%), mostly 12-48hours. The third COD was organ failure, in 9%(TRISS=25%), often >48hours.
Uncontrolled bleeding in patients with high probability of survival remains a challenge to reduce preventable trauma deaths.
•Uncontrolled bleeding with high survival probability remains a challenging priority to reduce preventable trauma deaths.•Timing and causes of trauma-related deaths remained essentially unchanged over the past three decades.•Traumatic hemorrhage associated deaths occur very early, within three hours postadmission.•Prospective adjudication of trauma deaths is critical to devise effective interventions.