Trends in 1029 trauma deaths at a level 1 trauma center: Impact of a bleeding control bundle of care
Section snippets
Methods
The trauma registry, weekly Morbidity & Mortality reports, autopsy reports and electronic medical records at Memorial Hermann Hospital in Houston, TX were reviewed. The Memorial Hermann Hospital is one of two level 1-trauma centers serving the greater Houston area and admits greater than 6000 injured patients a year.
Two time periods (2005–2006 and 2012–2013) were included in the analysis. These periods of time represent two years before and after implementation of major changes in control of
Results
We reviewed 15,874 and 1029 deaths from the 4-year study period. 7080 patients including 498 deaths were examined in the early time period (2005–2006), while 8767 patients including 531 deaths were reviewed in the recent period (2012–2013). There was a 23% increase in the number of admissions in the recent period. The overall trauma population showed differences in age and gender overtime but were similar in race/ethnicity distribution (Table 1). The median age of all patients increased by 6
Discussion
World wide, injury-related deaths has increased by 24% (1990–2010) [6], [7] while US data shows a 23% increase in death rate due to trauma over the past decade (2000–2010) [5], [6]. Dutton et al. [2010] in a similar single-site study showed an increase in mortality over time (1997–2008) [9]. However the data at our single-site study demonstrates a significant reduction in adjusted overall and in-hospital mortality. While our data does not reflect the entire population of the greater Houston
Conclusion
Injury is a leading cause of mortality in the US and around the world. The dominant causes of death are TBI and hemorrhage. In this single center retrospective study, we demonstrated a reduction in hemorrhagic death rates, while TBI and MOF/sepsis rates remained unchanged. This change was likely associated with implementing a multimodal bleeding control bundle of care, rather than any one specific intervention. Adequate funding for high quality prehospital and early hospital based intervention
Financial support
The Center for Translational Injury Research and The University of Texas Medical School at Houston- Office of the Dean.
Disclosure statement
The authors have nothing to disclose.
Acknowledgments
This study is supported by the Center for Translational Injury Research and The University of Texas Medical School at Houston Office of the Dean.
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