Polytrauma-related deaths in Moscow: Retrospective analysis of 969 autopsy studies

Polytrauma is still a challenge for health care organizations. Today, the search for factors to reduce lethality continues. This study aims to describe the causes of death associated with polytrauma in 1 year.

This retrospective study analyzed autopsy data of trauma deaths in Moscow for the whole of 2017. We identified victims with polytrauma, taking into account the Berlin definition as the main inclusion criteria with penetrating and blunt trauma. Each forensic report had information about the pre-hospital and hospital stages of treatment and autopsy data. The exclusion criteria for this study were: isolated injury, forensic reports not related to the examination of entire corpses, and autopsy studies of children (<18 years old). Statistical analysis was performed according to basic principles, including a comparison of groups using the Chi-squared test with Bonferroni comparison test and Fisher's exact test. The critical level of significance (p value) in testing statistical hypotheses in this study was taken as 0.05.

We analyzed 2337 forensic medical examinations of victims who died of trauma in Moscow in 2017, of which 41.5% (n = 969) were polytrauma deaths. Most of the victims (65.4%, n = 634) died on the scene, and only 30.0% were admitted to the hospital. The most frequent cause of death was bleeding (72.0%, n = 698), followed by traumatic brain injury (43.8%, n = 424). They accounted for the first peak (78.4%, p = 0.005) of deaths, occurring in the first hours. Then these causes of death in the first peak go down in a few hours, and the second peak of mortality appears in 3 - 7 days (p = 0.001).

This is the largest full-year autopsy study of polytrauma victims. Our data show that the main cause of polytrauma death is massive bleeding, with a lethality peak in the first hours after injury. The time distribution of polytrauma deaths has a bimodal pattern - the second period of polytrauma deaths occurs in 3 - 7 days.