Early deaths after severe blunt trauma in Level 1 Trauma Centers. A French multicenter cohort study.
Guillaume BODDAERT | Charlotte BALTAZARD
Seance of wednesday 26 june 2024 (Séance Commune avec le Service de Santé des Armées (S.S.A) au VAL DE GRÂCE)
DOI number : 10.26299/hyvt-x815/emem.2024.22.02
Abstract
Background: Management algorithms for blunt trauma are often derived from those for penetrating trauma, despite their completely different injury profiles. This study was conducted to specify the causes of death in the most severe blunt trauma cases, analyze the management strategies employed, and propose areas for improvement.
Methods: This retrospective observational multicentric study was conducted using the data of a prospective French national registry (TraumaBase®) from January 2017 to December 2022. Inclusion criteria were: blunt trauma who died within the first 24 hours in Level 1 Trauma Centres.
Results: Seven hundred twenty-two patients were included. The mean age was 50.7 (± 22.8) years with a male predominance (72.7%). Mechanisms involved were: n=404 road traffic accidents (56%), n=293 falls (40.6%), n=23 blunt object traumas (3.2%), and n=2 other mechanisms (0.3%). Median Injury Severity Score (ISS) was 30 (22-45). The anatomical regions affected were: n=590 head/neck (81.7%), n=426 thorax (59%), n=339 extremities (47%), n=251 abdomen (34.8%), n=184 face (25.5%), and n=86 skin (4.7%). Two-thirds (70.4%) were in haemorrhagic shock (HS), with the origin being abdominal (35%), pelvic (25.8%), or thoracic (15.2%). Haemostasis was achieved through open surgery (n=77, 61.1%) or interventional radiology (n=49, 38.9%). Five REBOA (0.7%) procedures were performed. Three main causes of mortality at 24 hours were: n=310 central nervous system (CNS) injury (42.9%), n=169 haemorrhage (23.4%), n=156 multi-organ failure (MOF) (21.6%). Potentially Preventable Death (PPD) accounted for 353 patients (48.9%).
Conclusions: Victims of severe blunt trauma should be considered as having concomitant life-threatening traumatic brain injury and non-compressible extra cranial haemorrhage. Every effort must be made to stabilize these patients, at least temporarily, to obtain rapid injury assessment through CT scanning to identify the “first lethal injury” to treat.
Authors: Charlotte Baltazard(1), Guillaume Boddaert(1,2)
(1) Thoracic and vascular department, Percy military hospital, Clamart, France
(2) French military health academy, École du Val-de-Grâce, Paris, France
Methods: This retrospective observational multicentric study was conducted using the data of a prospective French national registry (TraumaBase®) from January 2017 to December 2022. Inclusion criteria were: blunt trauma who died within the first 24 hours in Level 1 Trauma Centres.
Results: Seven hundred twenty-two patients were included. The mean age was 50.7 (± 22.8) years with a male predominance (72.7%). Mechanisms involved were: n=404 road traffic accidents (56%), n=293 falls (40.6%), n=23 blunt object traumas (3.2%), and n=2 other mechanisms (0.3%). Median Injury Severity Score (ISS) was 30 (22-45). The anatomical regions affected were: n=590 head/neck (81.7%), n=426 thorax (59%), n=339 extremities (47%), n=251 abdomen (34.8%), n=184 face (25.5%), and n=86 skin (4.7%). Two-thirds (70.4%) were in haemorrhagic shock (HS), with the origin being abdominal (35%), pelvic (25.8%), or thoracic (15.2%). Haemostasis was achieved through open surgery (n=77, 61.1%) or interventional radiology (n=49, 38.9%). Five REBOA (0.7%) procedures were performed. Three main causes of mortality at 24 hours were: n=310 central nervous system (CNS) injury (42.9%), n=169 haemorrhage (23.4%), n=156 multi-organ failure (MOF) (21.6%). Potentially Preventable Death (PPD) accounted for 353 patients (48.9%).
Conclusions: Victims of severe blunt trauma should be considered as having concomitant life-threatening traumatic brain injury and non-compressible extra cranial haemorrhage. Every effort must be made to stabilize these patients, at least temporarily, to obtain rapid injury assessment through CT scanning to identify the “first lethal injury” to treat.
Authors: Charlotte Baltazard(1), Guillaume Boddaert(1,2)
(1) Thoracic and vascular department, Percy military hospital, Clamart, France
(2) French military health academy, École du Val-de-Grâce, Paris, France