A five-year review of deaths following urban trauma

At Metropolitan Hospital Center, New York City, 3,000 patients with trauma were admitted during 1974 through 1978, with a mortality rate of 4%. One hundred eight patients who were admitted and diet were analyzed. Ages were from 3 months to 84 years with clusters in 15-30 and 45-60 years. Injury Severity Scores (ISS) ranged from 9 to 66 (37). All body systems were equally represented. Most patients had two systems involved. Abbreviated Injury Scale (AIS) scores for most severe systems were 5 in 60%, 4 in 34% and 3 in 6%. Shock was present in 52%. Major complications; sepsis in 30% (pulmonary, 20%); neurological, 12%; respiratory failure 15%; renal failure 10%. Surgical care was optimal in 45%. In the remaining 55% at least one error occurred: inappropriate or inadequate fluid resuscitation, 37%; missed or delayed diagnosis, 20%; airway management, 10%; surgical judgment, 8%; surgical techniques, 9%. ISS scores, error/no-error; shock/no-shock, showed no significant differences. Patients with AIS scores of 3 were elderly or had errors in management. Management errors continue to be made in a significant number of severely injured patients, and may contribute to the demise of patients with survivable injury. These data parallel those reported to this society by van Wagoner (13) in 1960 and Foley in 1976 (5).