• David T Efron, Adil Haider, David Chang, Elliott R Haut, Elliot R Haut, Benjamin Brooke, and Edward E Cornwell.
• Division of General and Gastrointestinal Surgery, Trauma, and Surgical Critical Care, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
• Arch Surg Chicago. 2006 Aug 1; 141 (8): 800-3; discussion 803-5.

HypothesisA growing proportion of urban trauma mortality is characterized by devastating and likely nonsurvivable injuries.DesignConsecutive samples from prospectively collected registry data.SettingUniversity level I trauma center.PatientsAll trauma patients from January 1, 2000, to March 31, 2005.Main Outcome MeasuresData for trauma patients, including locale of death and mechanism of injury, comparing early (years 2000 through 2003) and late (2004 and 2005) periods.ResultsA total of 11 051 trauma visits were registered during the study period with 366 deaths for an overall mortality of 3.3%. Penetrating injury occurred in 26.7% of patients; however, 71.9% of trauma mortalities (263 patients) died with penetrating injuries. Of the patients who died, 48.3% demonstrated severe penetrating injuries (Abbreviated Injury Score >/=4) to the head while 32.7% presented with severe penetrating chest injuries. There was a significant increase in the mortality rate over time (3.0% [early] vs 4.3% [late], P<.01). In parallel, emergency department mortality (patients dead on arrival and those not surviving to hospital admission) increased from 1.7% to 3.1% (P<.005), yet postadmission mortality remained constant (1.3% [early] vs 1.2% [late], P = .77). When emergency department mortality and the subsequent hospital mortality of patients with gunshot wounds to the head were combined, this represented 82.6% of all trauma mortalities in the late period. This was increased from 69.7% during the early period (P<.01).ConclusionsWhile in-hospital mortality has remained the same, the proportion of nonsurvivable traumatic injuries has increased. In a mature trauma system, this provides a compelling argument for violence prevention strategies to reduce urban trauma mortality.

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