An analysis of prehospital deaths: Who can we save?

James S. Davis, Shevonne S. Satahoo, Frank K. Butler, Harrison Dermer, Daniel Naranjo, Katherina Julien, Robert M. Van Haren, Nicholas Namias, Lorne H. Blackbourne, Carl I. Schulman

Research output: Contribution to journalArticle

71 Scopus citations

Abstract

BACKGROUND: Since their inception in the late 1970s, trauma networks have saved thousands of lives in the prehospital setting. However, few recent works have been done to evaluate the patients who die in the field. Understanding the epidemiology of these deaths is crucial for trauma system performance evaluation and improvement. We hypothesized that specific patterns of injury could be identified and targeted for intervention. METHODS: Medical examiner reports in a large, urban county were reviewed including all trauma deaths during 2011 that were not transported to a hospital (i.e., died at the scene) or dead on arrival. Age, sex, date of death, mechanism, and list of injuries were recorded. An expert panel reviewed each case to determine the primary cause of death, and if the patient's death was caused by potentially survivable injuries or nonsurvivable injuries. RESULTS: A total of 512 patients were included. Patients were 80% male, died mostly of blunt (53%) and penetrating (46%) causes, and included 21% documented suicides. The leading cause of death was neurotrauma (36%), followed by hemorrhage (34%), asphyxia (15%), and combined neurotrauma/hemorrhage (15%). The anatomic regions most frequently injured were the brain (59%), chest (54%), and abdomen (35%). Finally, 29% of the patient deaths were classified as a result of potentially survivable injuries given current treatment options, mostly from hemorrhage and chest injuries. CONCLUSION: More than one of every five trauma deaths in our study population had potentially survivable injuries. In this group, chest injuries and death via hemorrhage were predominant and suggest targets for future research and implementation of novel prehospital interventions. In addition, efforts targeting suicide prevention remain of great importance. LEVEL OF EVIDENCE: Epidemiologic study, level V.

Original languageEnglish (US)
Pages (from-to)213-218
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number2
DOIs
StatePublished - Aug 2014

Keywords

  • Death
  • Emergency medical services
  • Trauma
  • Wounds and injuries

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

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    Davis, J. S., Satahoo, S. S., Butler, F. K., Dermer, H., Naranjo, D., Julien, K., Van Haren, R. M., Namias, N., Blackbourne, L. H., & Schulman, C. I. (2014). An analysis of prehospital deaths: Who can we save? Journal of Trauma and Acute Care Surgery, 77(2), 213-218. https://doi.org/10.1097/TA.0000000000000292