Epidemiology of trauma: the civilian perspective

Recent interest in civilian trauma as a public health problem dates from the National Academy of Sciences white paper in 1966. Civilian trauma patterns vary depending on locale--blunt trauma predominates in rural and smaller urban areas (65% to 80% of hospital admissions); penetrating trauma in larger urban areas outweighs blunt trauma by a ratio of 2 to 1. Approximately 50% of trauma deaths occur within minutes of injury, and efforts at prevention and reduction of injury are the only hope for decreasing mortality in this group. Thirty percent of trauma deaths occur in the first few hours, and reducing this rate will require optimization of prehospital and early hospital care. Aggressive efforts at intensive care unit management will be required to reduce the number of later deaths (20%). Several studies suggest that limiting the depth and duration of shock is a major factor in reducing the in-hospital mortality rate. Reducing mortality and morbidity nationwide requires several things. Although it is clear that preventive efforts must focus on legislation and public education, it is also clear that enforcement is a key element (eg, handgun violations, drunk driving). Emphasis in prehospital care probably should remain on field endotracheal intubation and expeditious transport to an appropriate facility. Recent data suggest that organization of in-hospital care of the multiply injured trauma victim along the lines of a dedicated trauma service can lead to reductions in morbidity and mortality from trauma. Finally, the commitment of federal and private agencies to supporting research on all aspects of trauma must be raised to a level commensurate with the seriousness of this major public health problem.