Motor vehicle accidents in northeastern Ontario: are preadmission deaths inevitable?

A large proportion of deaths associated with motor vehicle accidents occur before the victim arrives at hospital. To determine whether these deaths are inevitable, we reviewed the autopsy records of 279 such patients in the Sudbury, Ont., region. The score on the abbreviated injury scale (1980 revision) was calculated for each case; 160 patients had a score of 6 (single fatal injuries) and were excluded from the study. The remaining 119 patients were considered to have had some potential for survival. The main injuries contributing to death were hemorrhage, airway dysfunction, pulmonary contusions and head injuries. Of the 119, 60 had evidence of central nervous system (CNS) injury. The mean injury severity scores (ISSs) for those with and without CNS injury were 37.3 and 33.3 respectively. Of the 64 patients with an ISS of 40 or less, 52 were judged to have had a likelihood of survival if improved trauma care before admission to hospital had been available in the Sudbury region.