An Analysis of Trauma Patient Deaths in the Emergency Department - an Opportunity for Performance Improvement...

Introduction: Trauma is a leading cause of presentation to the emergency department (ED). Improving outcomes requires identification of areas for potential improvement, as well as identifying factors of patients with non-survivable injuries that will unnecessarily consume resources. We sought to analyze the presentations of trauma patients who expired while still in the ED. Methods: We analyzed data from patients in the Trauma Quality Improvement Program (TQIP) registry whose death time was less than their ED length of stay to a maximum of 3 hours. We used descriptive statistics. Results: From 2020-2022, there were 3,575,106 encounters in the TQIP database, of which, 33,525 (0.93801%) met inclusion for this analysis. The median time from arrival to death was 11 minutes (IQR 4-26). Of the deaths, 20% (6617) had signs of life on arrival and 62% (20835) had no signs of life on arrival with the remainder lacking arrival vitals documentation. The maximum number of deaths in one facility was 174, 177, and 212, respectively. The median age was 36, and 79% were male. Of the pediatric patients, the 15 to 17 years age group comprised the largest proportion at 3%. Collisions and firearms were predominant injury mechanisms overall. The median composite injury severity score was 21 (IQR 9-30). Overall, serious injuries to the thorax accounted for the largest proportion at 50%. Of those that arrived with signs of life, serious injuries to the head/neck accounted for the largest proportion at 57%. Of those that arrived with no signs of life, serious injuries to the thorax comprised the large portion at 52%. Across all the groups, most deaths occurred at a Level I trauma center. Conclusions: Deaths in the ED setting relating to trauma were rare occurrences but often happened quickly after arrival. Substantial resources were consumed by the patients that rapidly died suggesting that we need better methods to predict those with a poor outcome. Moreover, our findings highlight areas for performance improvement and potential implementation at trauma centers within the Military Health System. Our findings are consistent with previous reports on causes of early death.