José A. Acosta

Lethal injuries and time to death in a level I trauma center

BACKGROUND The purpose of this study was to identify the causes and time to death of all trauma victims who died at a level I trauma center during an 11-year period. STUDY DESIGN Autopsies were performed on all patients who died secondary to trauma. Retrospective review of these autopsies was carried out and appended to existing trauma registry data. Standard definitions were used to attribute the cause of death in each case. Preventable deaths were determined by a standardized peer review process. RESULTS Between January 1985 and December 1995, a total of 900 trauma patients died. This represented 7.3% of all major trauma admissions (12,320). Seventy percent of these patients died within the first 24 hours of admission. Thoracic vascular and central nervous system (CNS) injuries were the most common causes of death in the first hour after admission to the hospital. CNS injuries were the most common causes of death within the 72 deaths after admission. Acute inflammatory processes (multiple organ failure, acute respiratory distress syndrome, and pneumonia) and pulmonary emboli were the leading causes of death after the first 72 hours. Overall, 43.6% (393 of 900) of all trauma deaths were caused by CNS injuries, making this the most common cause of death in our study. The preventable death rate was 1%. CONCLUSIONS The first 24 hours after trauma are the deadliest for these patients. Primary and secondary CNS injuries are the leading causes of death. Prevention, early identification, and treatment of potentially lethal injuries should remain the focus of those who treat trauma patients.Background: The purpose of this study was to identify the causes and time to death of all trauma victims who died at a level I trauma center during an 11-year period. Study Design: Autopsies were performed on all patients who died secondary to trauma. Retrospective review of these autopsies was carried out and appended to existing trauma registry data. Standard definitions were used to attribute the cause of death in each case. Preventable deaths were determined by a standardized peer review process. Results: Between January 1985 and December 1995, a total of 900 trauma patients died. This represented 7.3% of all major trauma admissions (12,320). Seventy percent of these patients died within the first 24 hours of admission. Thoracic vascular and central nervous system (CNS) injuries were the most common causes of death in the first hour after admission to the hospital. CNS injuries were the most common causes of death within the 72 deaths after admission. Acute inflammatory processes (multiple organ failure, acute respiratory distress syndrome, and pneumonia) and pulmonary emboli were the leading causes of death after the first 72 hours. Overall, 43.6% (393 of 900) of all trauma deaths were caused by CNS injuries, making this the most common cause of death in our study. The preventable death rate was 1%. Conclusions: The first 24 hours after trauma are the deadliest for these patients. Primary and secondary CNS injuries are the leading causes of death. Prevention, early identification, and treatment of potentially lethal injuries should remain the focus of those who treat trauma patients.

Original Scientific ArticlesLethal Injuries and Time to Death in a Level I Trauma Center 1

BACKGROUND The purpose of this study was to identify the causes and time to death of all trauma victims who died at a level I trauma center during an 11-year period. STUDY DESIGN Autopsies were performed on all patients who died secondary to trauma. Retrospective review of these autopsies was carried out and appended to existing trauma registry data. Standard definitions were used to attribute the cause of death in each case. Preventable deaths were determined by a standardized peer review process. RESULTS Between January 1985 and December 1995, a total of 900 trauma patients died. This represented 7.3% of all major trauma admissions (12,320). Seventy percent of these patients died within the first 24 hours of admission. Thoracic vascular and central nervous system (CNS) injuries were the most common causes of death in the first hour after admission to the hospital. CNS injuries were the most common causes of death within the 72 deaths after admission. Acute inflammatory processes (multiple organ failure, acute respiratory distress syndrome, and pneumonia) and pulmonary emboli were the leading causes of death after the first 72 hours. Overall, 43.6% (393 of 900) of all trauma deaths were caused by CNS injuries, making this the most common cause of death in our study. The preventable death rate was 1%. CONCLUSIONS The first 24 hours after trauma are the deadliest for these patients. Primary and secondary CNS injuries are the leading causes of death. Prevention, early identification, and treatment of potentially lethal injuries should remain the focus of those who treat trauma patients.Background: The purpose of this study was to identify the causes and time to death of all trauma victims who died at a level I trauma center during an 11-year period. Study Design: Autopsies were performed on all patients who died secondary to trauma. Retrospective review of these autopsies was carried out and appended to existing trauma registry data. Standard definitions were used to attribute the cause of death in each case. Preventable deaths were determined by a standardized peer review process. Results: Between January 1985 and December 1995, a total of 900 trauma patients died. This represented 7.3% of all major trauma admissions (12,320). Seventy percent of these patients died within the first 24 hours of admission. Thoracic vascular and central nervous system (CNS) injuries were the most common causes of death in the first hour after admission to the hospital. CNS injuries were the most common causes of death within the 72 deaths after admission. Acute inflammatory processes (multiple organ failure, acute respiratory distress syndrome, and pneumonia) and pulmonary emboli were the leading causes of death after the first 72 hours. Overall, 43.6% (393 of 900) of all trauma deaths were caused by CNS injuries, making this the most common cause of death in our study. The preventable death rate was 1%. Conclusions: The first 24 hours after trauma are the deadliest for these patients. Primary and secondary CNS injuries are the leading causes of death. Prevention, early identification, and treatment of potentially lethal injuries should remain the focus of those who treat trauma patients.

Guidelines for Management of Small Bowel Obstruction

STATEMENT OF THE PROBLEMThe description of patients presenting with small bowel obstruction (SBO) dates back to the third or fourth century, when early surgeons created enterocutaneous fistulas to relieve a bowel obstruction. Despite this success with operative therapy, the nonoperative management o

Morbidity associated with four-wheel all-terrain vehicles and comparison with that of motorcycles

BACKGROUND The U.S. Consumer Product Safety Commission in their annual report (2001) of all-terrain vehicle (ATV) deaths and injuries concluded that in the late 1990s there had been a gradual increase in the number of deaths and injuries related to ATV collisions. The objective of our study was to describe the morbidity of four-wheel all-terrain vehicle collisions (ATVCs) and compare them with motorcycle collision (MCC) victims. METHODS This was a 24-month (April 2000-November 2002) retrospective review of all trauma patients admitted. Statistical significance was defined at p < 0.05. RESULTS A total of 2,380 blunt trauma patients were admitted, of which 74 (3.1%) were ATVC victims and 169 (7.1%) were MCC victims. The average age was 23.9 +/- 9.4 years for ATVC victims and 29.1 +/- 11.5 years (p < 0.001) for MCC victims. The median Injury Severity Score was 16.0 for the ATVC group and 13 for the MCC group (p = 0.106). ATVC patients had a higher incidence of head and neck injuries (56%) than MCC patients (30%) (p < 0.001). The incidence of chest and abdominal injuries was similar between groups. Mortality occurred in 15 of 74 (20%) ATVC patients and 24 of 169 (14.2%) MCC patients (p = 0.236). CONCLUSION This study demonstrates that ATVCs are associated with significant morbidity and mortality. When compared with MCCs, ATVCs have similar mortality and a much higher incidence of head injuries. National tracking of ATVCs should be continued and improved in an effort to assist legislators in enacting laws protecting the riders of ATVs.