[Epidemiological profile of late mortality in severe polytraumatisms]

Abstract

Objective: A study is made of the epidemiology, chronogramand causes of late mortality in traumatized patients.

Design: A prospective, observational cohort study of adult trauma patients was carried out.

Settings: Province of Guipúzcoa (Basque Country, Spain). Intensive care unit of a tertiary hospital.

Patients: Patients with severe trauma (Injury Severity Score > 15), admitted to the ICU from January 1995 to December 2009, with late death (> 7 days).

Variables: Epidemiological, laboratory test, hemodynamic and transfusional data were collected. Severity scores: Abbreviated Injury Scale (AIS) and ISS.

Results: Patients: 2003; ISS: 24.3±14.2. Total deaths: 405 (20%). Late mortality (>7 days): 102 (25.2%) patients, 9 years older and with a lower (18 points) ISS score than the patients who died early (48 hours). Most frequent injuries: AIS-Head-Cervical spine ≥ 4 (52%); AIS-Abdomen ≥ 4 (19.6%); AIS-Chest ≥ 4 (11.7%); AIS-Extremities ≥ 4 (4.9%). Causes of death: 1) brain death (14.7%); 2) multiorgan failure (67.6%), in two injury contexts: a) severe brain trauma in the vegetative state and high spinal cord injuries with tetraplegia (35.3%); and b) non-neurological injuries (32.3%) with a high prevalence of hypovolemic shock, multiple transfusion and coagulopathy; 3) miscellaneous (10.7%): post-resuscitation anoxic-ischemic encephalopathy, pulmonary embolism and massive stroke; 4) non-evaluable (7%).

Conclusions: Age, severity and type of injuries have an influence upon the time distribution and causality of late mortality. Brain death remains predominant, with multiorgan failure as the most frequent cause. This knowledge should contribute to the identification of problems, and to better organization of the structural and educational resources, thereby reducing the likely factors leading to death from trauma.

Keywords: Epidemiologia; Epidemiology; Fracaso multiorgánico; Late mortality; Mortalidad; Mortalidad tardía; Multiple organ failure; Trauma; Trauma death; Traumatismo.