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

Background: Unlike previous studies in an urban environment, this study examines traumatic death in a geographically diverse county in the southwestern United States. Methods: All deaths from blunt and penetrating trauma between November 15, 1991, and November 14, 1993, were included. As many as 150 variables were collected on each patient, including time of injury and time of death. Initial identification of cases was through manual review of death records. Information was supplemented by review of hospital records, case reports, and prehospital encounter forms. Results: A total of 710 traumatic deaths were analyzed. Approximately half of the victims, 52%, were pronounced dead at the scene. Of the 48% who were hospitalized, the most frequent mechanism of injury was a fall. Neurologic dysfunction was the most common cause of death. Two distinct peaks of time were found on analysis: 23% of patients died within the first 60 minutes, and 35% of patients died at 24 to 48 hours after injury. Conclusions: Although there appears to continue to be a trimodal distribution of trauma deaths in urban environments, we found the distribution to be bimodal in an environment with a higher ratio of blunt to penetrating trauma.