Distribution of Trauma Deaths in a Province of Korea: Is “Trimodal” Distribution Relevant Today?

PURPOSE: This study was designed to provide a basis for building a master plan for a regional trauma system by analyzing the distribution of trauma deaths in the most populous province in Korea.MATERIALS AND METHODS: We investigated the time distribution to death for trauma patients who died between January and December 2017. The time distribution to death was categorized into four groups (within a day, within a week, within a month, and over a month). Additionally, the distribution of deaths within 24 hours was further analyzed. We also reviewed the distribution of deaths according to the cause of death and mechanism of injury.RESULTS: Of the 1546 trauma deaths, 328 cases were included in the final study population. Patients who died within a day were the most prevalent (40.9%). Of those who died within a day, the cases within an hour accounted for 40.3% of the highest proportion. The majority of trauma deaths within 4 hours were caused by traffic-related accidents (60.4%). The deaths caused by bleeding and central nervous system injuries accounted for most (70.1%) of the early deaths, whereas multi-organ dysfunction syndrome/sepsis had the highest ratio (69.7%) in the late deaths. Statistically significant differences were found in time distribution according to the mechanism of injury and cause of death (p<0.001).CONCLUSION: The distribution of overall timing of death was shown to follow a bimodal pattern rather than a trimodal model in Korea. Based on our findings, a suitable and modified trauma system must be developed.

Distribution of Time to Death in Trauma Patients: A Review of 11 years' Experience at a Tertiary Care Teaching Hospital

BACKGROUND: Traumatic death occupies a high ranking in the annual national report on causes of death and causes a significant burden to society. To reduce traumatic death, an area-wide trauma care system is urgently needed, and basic mortality data will be an essential component in designing such a system. The purpose of this study was to review the experience of trauma death in a hospital to determine the pattern of time to death and the effect of the emergency medical services(EMS) system in traumatic death. METHODS: A retrospective analysis of 495 traumatic deaths experienced from 1990 to 2000 was performed. Time to death, mechanism of injury, injury severity, and cause of death were reviewed. The influence of the EMS system before 1995 was compared with its influence after 1995. RESULTS: The mean age of the 495 patients was 41.1+/-18.9 and the mean injury severity score(ISS) was 37.1+/-17.8. The distribution of time to death showed DOA(including found dead) in 39% of the cases, within 48hr in 38.4%, between the 2nd and 7th days in 9.9%, and later than the 7th day in 12.7%. The majority of early deaths occurred within 4 hr of injury, but a minor increase was noted during the 2nd week. After 1995, the ambulance transportation rate increased significantly without any difference in prehospital interventions. CONCLUSION: Our results showed a bimodal distribution of time to death, which reflected geographic, mechanism of injury, and trauma care system differences. We also noted deficiencies in prehospital trauma care in our EMS system. We recommend nationwide trauma registry initiatives to provide basic trauma data and to implement a quality trauma care system.