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August 1, 2006

Alarming Surge in Nonsurvivable Urban Trauma and the Case for Violence Prevention

Author Affiliations

Author Affiliations: Division of General and Gastrointestinal Surgery, Trauma, and Surgical Critical Care, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Md.

Arch Surg. 2006;141(8):800-805. doi:10.1001/archsurg.141.8.800

Hypothesis  A growing proportion of urban trauma mortality is characterized by devastating and likely nonsurvivable injuries.

Design  Consecutive samples from prospectively collected registry data.

Setting  University level I trauma center.

Patients  All trauma patients from January 1, 2000, to March 31, 2005.

Main Outcome Measures  Data for trauma patients, including locale of death and mechanism of injury, comparing early (years 2000 through 2003) and late (2004 and 2005) periods.

Results  A total of 11 051 trauma visits were registered during the study period with 366 deaths for an overall mortality of 3.3%. Penetrating injury occurred in 26.7% of patients; however, 71.9% of trauma mortalities (263 patients) died with penetrating injuries. Of the patients who died, 48.3% demonstrated severe penetrating injuries (Abbreviated Injury Score ≥4) to the head while 32.7% presented with severe penetrating chest injuries. There was a significant increase in the mortality rate over time (3.0% [early] vs 4.3% [late], P<.01). In parallel, emergency department mortality (patients dead on arrival and those not surviving to hospital admission) increased from 1.7% to 3.1% (P<.005), yet postadmission mortality remained constant (1.3% [early] vs 1.2% [late], P = .77). When emergency department mortality and the subsequent hospital mortality of patients with gunshot wounds to the head were combined, this represented 82.6% of all trauma mortalities in the late period. This was increased from 69.7% during the early period (P<.01).

Conclusions  While in-hospital mortality has remained the same, the proportion of nonsurvivable traumatic injuries has increased. In a mature trauma system, this provides a compelling argument for violence prevention strategies to reduce urban trauma mortality.