Skip to Main Content

EPIDEMIOLOGY OF TRAUMA

As a “disease,” trauma is a major public health problem. In the United States, it is the leading cause of death among people aged 1-45. Among the young, trauma is responsible for more deaths than all other diseases combined and results in the loss of more working years than all other causes of death. The prevalence of injury in the elderly population is also significant; 6% of Medicare inpatient admissions have traumatic injury as their primary diagnosis. The presence of alcohol is a significant contributor to trauma fatalities, and one-third of all traffic deaths are alcohol related. The economic costs of injury are substantial, exceeding $4.2 trillion annually ($327 billion in medical care; $69 billion in work loss; $3.8 trillion in value of statistical life-years and quality-of-life losses). Regrettably, nearly 40% of all trauma deaths could be avoided by injury-prevention measures, alcohol cessation, and the establishment of regional trauma systems that would expedite the evaluation and treatment of seriously injured patients.

Trauma deaths have classically been described as having a trimodal distribution (Figure 16–1A), with peaks that correspond to the types of intervention that would be most effective in reducing mortality. However, with advancements in care and maturation of trauma systems, the trimodal concept no longer applies. The incidence of late deaths has declined from 20% to 7%-8% of all deaths, and early deaths have shifted toward the left, creating a bimodal distribution (Figure 16–1B). Early deaths still predominate, with the remainder dying at a slow rate over many days. Immediate deaths represent patients who die of their injuries before reaching the hospital. The injuries accounting for these deaths include major brain or spinal cord trauma and those resulting in rapid exsanguination. Few of these patients have any chance of survival even with access to immediate care because almost 60% of these deaths occur at the same time as the injury. Prevention remains the major strategy to reduce these deaths.

Figure 16–1.

Mortality timing: Periods of peak mortality after injury. A. Historical. B. Current. (Part A: Reproduced with permission from Hoyt DB, Coimbra R. Trauma: Introduction. In: Greenfield LJ, Mulholland MW, Oldham KT, et al. Surgery, Scientific Principles and Practice, 2nd ed. Lippincott Williams & Wilkins; 1997. Part B: Reproduced with permission from Gunst M, Ghaemmaghami V, Gruszecki A, et al. Changing epidemiology of trauma deaths leads to a bimodal distribution. Proc Bayl Univ Med Cent. 2010;23:349.)

Early deaths are those that occur within the first few hours after injury. Half are caused by internal hemorrhage, and the other half by central nervous system injuries. Almost all of these injuries are potentially treatable. However, in most cases, salvage requires prompt and definitive care of the sort available at a trauma center, which is a specialized institution that can provide immediate resuscitation, identification of injuries, ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

  • Create a Free Profile