Characterizing Early Inpatient Death After Trauma

Area of Science:

• Trauma critical care
• Emergency medicine
• Surgical outcomes

Background:

• Limited data exists for predicting early mortality or futility in trauma patients.
• This study aimed to identify predictors of death within 72 hours of trauma admission.

Purpose of the Study:

• To characterize laboratory values, blood product administration, and hospital disposition for trauma patients who died within 72 hours.
• To identify factors associated with early death after trauma.

Main Methods:

• Retrospective review of trauma deaths within 72 hours at a Level I trauma center over 5 years.
• Analysis of blood transfusion within 4 hours and emergency department disposition (OR, SICU, NSICU).
• Kaplan-Meier curves used to determine time to death.

Main Results:

• 622 subjects identified; 39.5% died in the ED.
• Early blood transfusion (within 4 hours) was associated with more rapid death in NSICU patients (P=0.01).
• Admission coagulopathy (INR) correlated with shorter time to death (P<0.01), unlike anemia or acidosis.

Conclusions:

• Admission coagulation derangement and early blood product transfusion are key predictors of early death in trauma.
• These factors are particularly significant in patients with traumatic brain injury.
• Findings can inform the development of futility models for trauma patient care.