Factors Contributing to Death of Major Trauma Victims with Haemorrhage: A Retrospective Case-Control Study
Authors List
Carne, B., Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
Raina, A., Te Whatu Ora - Capital, Coast and Hutt Valley, Wellington, New Zealand
Bothara, R., Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
McCombie, A., Te Whatu Ora - Waitaha Canterbury and University of Otago, Christchurch, New Zealand
Fleischer, D., Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
Joyce, L., Te Whatu Ora - Waitaha Canterbury and University of Otago, Christchurch, New Zealand
Introduction
Trauma is a major cause of morbidity and mortality worldwide. Yearly in Canterbury, an estimated 5 major trauma victims (Injury Severity Score ≥12) die from haemorrhage or a secondary cause, such as multiple organ failure (MOF). It is not known why these individuals die, while others with a similar degree of injury survive. Previous literature has identified factors that may be associated with death secondary to haemorrhage. However, there are others that have not been investigated, and may be specific to New Zealand.
Aims
To identify factors associated with death secondary to haemorrhage following major trauma.
Methods
A retrospective case-control study was conducted on adult major trauma patients attending Christchurch Hospital Emergency Department (ED) between 01/06/16 and 01/06/20. Cases (those who died due to haemorrhage or MOF), were matched to controls (those who survived) in a 1:5 ratio. A multivariate analysis was used to identify potential risk factors for death due to haemorrhage.
Results
1540 major trauma patients were admitted to Christchurch Hospital or died in ED during the study period. 19 (1.2%) died from haemorrhage or MOF. After controlling for age and injury severity, having a lower temperature on ED arrival was a significant risk factor for death.
Conclusions
This study reaffirms previous literature that lower body temperature on presentation to hospital is a significant potentially modifiable variable in predicting death following major trauma. Further studies should investigate whether all pre-hospital services have Key Performance Indicators (KPIs) for temperature management, and causes for failure to reach these. Our findings should promote development and tracking of such KPIs where they do not already exist1.
References
Carne, B., Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
Raina, A., Te Whatu Ora - Capital, Coast and Hutt Valley, Wellington, New Zealand
Bothara, R., Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
McCombie, A., Te Whatu Ora - Waitaha Canterbury and University of Otago, Christchurch, New Zealand
Fleischer, D., Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
Joyce, L., Te Whatu Ora - Waitaha Canterbury and University of Otago, Christchurch, New Zealand
Introduction
Trauma is a major cause of morbidity and mortality worldwide. Yearly in Canterbury, an estimated 5 major trauma victims (Injury Severity Score ≥12) die from haemorrhage or a secondary cause, such as multiple organ failure (MOF). It is not known why these individuals die, while others with a similar degree of injury survive. Previous literature has identified factors that may be associated with death secondary to haemorrhage. However, there are others that have not been investigated, and may be specific to New Zealand.
Aims
To identify factors associated with death secondary to haemorrhage following major trauma.
Methods
A retrospective case-control study was conducted on adult major trauma patients attending Christchurch Hospital Emergency Department (ED) between 01/06/16 and 01/06/20. Cases (those who died due to haemorrhage or MOF), were matched to controls (those who survived) in a 1:5 ratio. A multivariate analysis was used to identify potential risk factors for death due to haemorrhage.
Results
1540 major trauma patients were admitted to Christchurch Hospital or died in ED during the study period. 19 (1.2%) died from haemorrhage or MOF. After controlling for age and injury severity, having a lower temperature on ED arrival was a significant risk factor for death.
Conclusions
This study reaffirms previous literature that lower body temperature on presentation to hospital is a significant potentially modifiable variable in predicting death following major trauma. Further studies should investigate whether all pre-hospital services have Key Performance Indicators (KPIs) for temperature management, and causes for failure to reach these. Our findings should promote development and tracking of such KPIs where they do not already exist1.
References
- Carne, B., Raina, A., Bothara, R., McCombie, A., Fleischer, D. and Joyce, L.R. (2023). Factors contributing to death of major trauma victims with haemorrhage: A retrospective case–control study. Emergency Medicine Australasia. doi:https://doi.org/10.1111/1742-6723.14275.
