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Identifying the first lethal injury in blunt polytrauma patients: Insights from a French multicenter cohort study
Background:
Blunt trauma is the main trauma mechanism leading to severe trauma, mortality and disability. Improving data on early death would help in improving current trauma management.
Methods:
This retrospective observational multicentric study was conducted using data from a prospective French national registry (TraumaBase) from January 2017 to December 2022. Inclusion criteria were: blunt trauma who died within the first 24 h in Level 1 Trauma Centers.
Results:
Seven hundred twenty-two patients were included. The mean age was 51 (SD 23) years with a male predominance (72.7 %). Mechanisms involved were: road traffic accidents (n = 404, 56.0 %), falls (n = 293, 40.6 %), blunt object traumas (n = 23, 3.2 %), and other mechanisms (n = 2, 0.3 %). Median Injury Severity Score (ISS) was 30 (22-45). The anatomical regions affected were: head/neck (n = 590, 81.7 %), thorax (n = 426, 59.0 %), extremities (n = 339, 47.0 %), abdomen (n = 251, 34.8 %), face (n = 184, 25.5 %), and skin (n = 86, 4.7 %). Two-thirds (n = 508, 70.4 %) of patients presented hemorrhagic shock (HS), with the origin being abdominal (35.0 %), pelvic (25.8 %), or thoracic (15.2 %). Hemostasis was achieved through open surgery (n = 77/126, 61.1 %) or interventional radiology (n = 49/126, 38.9 %). The three main causes of mortality at 24 h were: central nervous system (CNS) injury (n = 310, 42.9 %), hemorrhage (n = 169, 23.4 %), multi-organ failure (MOF) (n = 156, 21.6 %). Potentially Preventable Death (PPD) accounted for 353 patients (48.9 %).
Conclusions:
Early mortality causes after severe blunt trauma in France were neurological (42.9 %), hemorrhagic (23.4 %), and MOF (21.6 %). Among patients with traumatic brain injury (TBI), 65.2 % presented concomitant HS. Hemorrhage remained the second presumed cause of death among PDD, with pelvic origin being the most frequent. Victims of severe blunt trauma should be considered as having isolated or concomitant life-threatening traumatic brain injury and non-compressible extra cranial hemorrhage. Every effort must be made to stabilize these patients, at least temporarily, to obtain rapid injury assessment to identify the "first lethal injury" to treat.
