Background: Securing high-quality mortality statistics requires systematic evaluation of all trauma deaths. We\nexamined the proportion of trauma patients dying within 30 days from causes not related to the injury and the\nimpact of exclusion of patients dead on arrival on 30-day trauma mortality. We also defined the demographics,\ninjury characteristics, cause of death and time to death in patients admitted to our trauma center who died within\n30 days, between 2007-2011.\nMethods: Demographics, injury characteristics, status alive/dead on arrival, cause of death and time to death of\nall patients were reviewed. Deaths were analyzed based on injury mechanism (penetrating, blunt trauma and\nlow energy blunt trauma) and cause of death (traumatic brain injury (TBI), hemorrhage, organ dysfunction and\nother/unknown).\nResults: Of the 7422 admissions, 343 deaths were identified of which 36 (10.5%) involved causes not related to\nthe injury. The overall age was 71 years, Injury Severity Score (ISS) 29 and time to death 24 hours (all medians).\nFifty-four patients (17.6%) were dead on arrival. Exclusion of patients dead on arrival reduced the overall mortality\nrate (P < 0.05) and median ISS (P < 0.05) and increased median age (P < 0.01) and time to death (P < 0.001). Injury\nmechanism was penetrating trauma in 7.5%, blunt trauma in 56.0%, and low energy blunt trauma in 36.5%. TBI\naccounted for 58.6%; hemorrhage 16.3%, organ dysfunction 15.0%, and other/unknown for 10.1% of the deaths.\nPatients who died after low energy blunt trauma were older, had lower ISS and longer time to death compared\nto those who died after penetrating and blunt trauma (all P < 0.01).\nConclusions: Clinical review of all trauma deaths was essential to interpret mortality. Thirty-day trauma mortality\nincluded 10.5% deaths not directly related to the injury and the exclusion of patients dead on arrival significantly\naffected the unadjusted mortality rate, ISS, median age and time to death.
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