Changes in the temporal distribution of in-hospital mortality in severely injured patients-An analysis of the TraumaRegister DGU

Rauend Rauf, Francesca von Matthey, Moritz Croenlein, Michael Zyskowski, Martijn van Griensven, Peter Biberthaler, Rolf Lefering, Stefan Huber-Wagner, Section NIS of DGU

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BACKGROUND: The temporal distribution of trauma mortality has been classically described as a trimodal pattern with an immediate, early and late peak. In modern health care systems this time distribution has changed.

METHODS: Data from the TraumaRegister DGU was analysed retrospectively. Between 2002 and 2015, all registered in-hospital deaths with an Injury Severity Score (ISS) ≥ 16 were evaluated considering time of death, trauma mechanism, injured body area, age distribution, rates of sepsis and multiple organ failure. Pre-hospital and post-discharge trauma deaths were not considered.

RESULTS: 78 310 severely injured patients were registered, non-survivors constituted 14 816, representing an in-hospital mortality rate of 18.9%. Mean ISS of non-survivors was 36.0±16.0, 66.7% were male, mean age was 59.5±23.5. Within the first hour after admission to hospital, 10.8% of deaths occurred, after 6 hours the percentage increased to 25.5%, after 12 hours 40.0%, after 24 hours 53.2% and within the first 48 hours 61.9%. Mortality showed a constant temporal decrease. Severe head injury (defined by Abbreviated Injury Scale, AIS-Head≥3) was found in 76.4% of non-survivors. Patients with an isolated head injury showed a more distinct decrease in survival rate, which was accentuated in the first days after admission. The correlation of age and time of death showed a proportional increase with age (55-74a). The rate of sepsis and multiple organ failure among non-survivors was 11.5% and 70.1%, respectively.

CONCLUSION: In a modern trauma care system, the mortality distribution of severely injured patients has changed its pattern, where especially the third peak is no longer detectable.

Original languageEnglish
Article number0212095
Pages (from-to)e0212095
Number of pages15
Issue number2
Publication statusPublished - 22 Feb 2019
Externally publishedYes


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Rauf, R., von Matthey, F., Croenlein, M., Zyskowski, M., van Griensven, M., Biberthaler, P., Lefering, R., Huber-Wagner, S., & Section NIS of DGU (2019). Changes in the temporal distribution of in-hospital mortality in severely injured patients-An analysis of the TraumaRegister DGU. PLOS ONE, 14(2), e0212095. [0212095].