Date Published: June 4, 2019
Publisher: Public Library of Science
Author(s): Ben Beck, Karen Smith, Eric Mercier, Belinda Gabbe, Richard Bassed, Biswadev Mitra, Warwick Teague, Josine Siedenburg, Susan McLellan, Peter Cameron, Bruno Masquelier.
Trauma is a leading cause of mortality. Holistic views of trauma systems consider injury as a public health problem that requires efforts in primary, secondary and tertiary prevention. However, the performance of trauma systems is commonly judged on the in-hospital mortality rate. Such a focus misses opportunities to consider all deaths within a population, to understand differences in in-hospital and out-of-hospital trauma deaths and to inform population-level injury prevention efforts. The aim of this study was to provide an epidemiological overview of out-of-hospital and in-hospital trauma deaths in a geographically-defined area over a 10-year period.
We performed a population-based review of out-of-hospital and in-hospital trauma deaths over the period of 01 July 2006 to 30 June 2016 in Victoria, Australia, using data from the National Coronial Information System and the Victorian State Trauma Registry. Temporal trends in population-based incidence rates were evaluated.
Over the study period, there were 11,246 trauma deaths, of which 71% were out-of-hospital deaths. Out-of-hospital trauma deaths commonly resulted from intentional self-harm events (50%) and transport events (35%), while in-hospital trauma deaths commonly resulted from low falls (≤1 metre) (50%). The incidence of overall trauma deaths did not change over the study period (incidence rate ratio 0.998; 95%CI: 0.991, 1.004; P = 0.56).
Out-of-hospital deaths accounted for most trauma deaths. Given the notable differences between out-of-hospital and in-hospital trauma deaths, monitoring of all trauma deaths is necessary to inform injury prevention activities and to reduce trauma mortality. The absence of a change in the incidence of both out-of-hospital and in-hospital trauma deaths demonstrates the need for enhanced activities across all aspects of injury prevention.
Trauma is a leading cause of mortality worldwide.[1, 2] Vital statistics systems are often used to record injury causes of death and changes over time.[1, 2] However, such systems do not enable the identification of the proportion of deaths that die in the out-of-hospital setting compared to the in-hospital setting.
Over the 10-year period, there were 11,246 trauma deaths, of which 8,032 (71%) were out-of-hospital deaths and 3,214 (29%) were in-hospital deaths. The overall crude incidence was 20.3 deaths per 100,000 population with an average of 1,125 trauma deaths per year. The crude incidence of out-of-hospital trauma deaths (14.4 deaths per 100,000 population) was greater than in-hospital trauma deaths (5.8 deaths per 100,000 population). Overall, these trauma deaths were mostly male (72%), occurred in major cities (64%), and resulted from unintentional (56%), and intentional self-harm (37%), events (Table 1). Transport events (32%) and hangings (24%) were the leading causes of injury.
In this population-based study of out-of-hospital and in-hospital trauma deaths over a 10-year period, we demonstrated no change in the incidence of all trauma deaths. We observed age-related shifts in trauma death rates, with declines in children and increases in adults, particularly older adults. Intentional self-harm events accounted for half of all out-of-hospital trauma deaths and, in the most recent year of data, hangings were the leading cause of out-of-hospital trauma deaths.
In this comprehensive and population-based review of out-of-hospital trauma deaths, almost three-quarters of trauma deaths occurred in the out-of-hospital setting. Intentional self-harm and transport events were the leading cause of injury for out-of-hospital trauma deaths, while low falls were the predominant cause of in-hospital trauma deaths. Overall incidence of trauma deaths demonstrated little change, highlighting the need for enhanced and data-driven injury prevention strategies.