Fatal trauma: The modal distribution of time to death as a function of patient demographics and regional resurces

The study included all deaths due to injury occurring under the jurisdiction of the County Medical Examiner (ME) between November 15, 1991, and November 14, 1993. Exclusions included deaths due to drowning, poisonings, overdoses, or burns; patients transported by private vehicle; or those injuries or deaths occurring outside the county or on Native American land. The area under study covered approximately 9,100 square miles and included one major metropolitan area. Most residents in the county had access to 911, although a portion residing in sparsely populated, frontier areas did not. Cases were identified by manual review of death records in the MEs office. Other sources of information included hospital records, trauma registries, and EMS reports. A consensus approach was utilized to develop standard definitions for time of death, time of injury, and dispatch time. Each case was assigned to an outcome category based on injuries as coded by 1CD-9 CM codes. These were neurologic, circulatory collapse or hemorrhage, ventilatory, sepsis, organ failure, or other. A total of 776 deaths were recorded, with 56 not meeting inclusion criteria. Fifty-two percent of the victims were pronounced dead on the scene, and the most common mechanism of injury was self-inflicted gunshot wounds. This study noted a bimodal distribution of death. The greatest number of deaths occurred 24-48 hours after injury; half of these were classified as neurologic, and another 42% were from circulatory collapse or hemorrhage. Patients expiring within 60 minutes of injury formed the next highest peak: 46.3% were neurologic and 31.3% were from circulatory collapse. Falls were found to be the most common mechanism in patients dying 2 days to 3 weeks after trauma.