Is the trimodal pattern of death after trauma a dated concept in the 21st century? Trauma deaths in Auckland 2004.

OBJECTIVE

To determine whether the classical trimodal distribution of trauma deaths is still applicable in a contemporary urban New Zealand trauma system.

METHODS

All trauma deaths in the greater Auckland region between 1 January 2004 and 31 December 2004 were identified and reviewed. Data was obtained from hospital trauma registries, coroner autopsy reports and police reports.

RESULTS

There were 186 trauma deaths. The median age was 28.5 years and the median Injury Severity Score was 25. The predominant mechanisms of injury were hanging (36%), motor vehicle crashes (31.7%), falls (9.7%), pedestrian-vehicle injury (5.4%), stabbing (4.3%), motorcycle crashes (3.2%), and pedestrian-train injury (2.2%). Most deaths were from central nervous system injury (71.5%), haemorrhage (15.6%), and airway/ventilation compromise (3.8%). Multi-organ failure accounted for 1.6% of deaths. Most deaths occurred in the pre-hospital setting (80.6%) with a gradual decrease thereafter.

CONCLUSION

There was a skew towards early deaths. The trimodal distribution of trauma deaths was not demonstrated in this group of patients.