Factors contributing to death of major trauma victims with haemorrhage: A retrospective case-control study

To identify factors associated with death secondary to haemorrhage following major trauma.

A retrospective case-control study was conducted on data from adult major trauma patients attending Christchurch Hospital ED between 1 June 2016 and 1 June 2020. Cases (those who died due to haemorrhage or multiple organ failure [MOF]), were matched to controls (those who survived) in a 1:5 ratio from the Canterbury District Health Board major trauma database. A multivariate analysis was used to identify potential risk factors for death due to haemorrhage.

One thousand, five hundred and forty major trauma patients were admitted to Christchurch Hospital or died in ED during the study period. Of them, 140 (9.1%) died from any cause, most attributed to a central nervous system cause of death; 19 (1.2%) died from haemorrhage or MOF. After controlling for age and injury severity, having a lower temperature on arrival in ED was a significant modifiable risk factor for death. Additionally, intubation prior to hospital, increased base deficit, lower initial haemoglobin and lower Glasgow Coma Scale were risk factors associated with death.

The present study reaffirms previous literature that lower body temperature on presentation to hospital is a significant potentially modifiable variable in predicting death following major trauma. Further studies should investigate whether all pre-hospital services have key performance indicators (KPIs) for temperature management, and causes for failure to reach these. Our findings should promote development and tracking of such KPIs where they do not already exist.