• Dries Helsloot, Mark C Fitzgerald, Rolf Lefering, Sandra Verelst, Carlo Missant, and TraumaRegister DGU®.
• From the Department of Anaesthesiology & Emergency Medicine, AZ Groeninge Hospital (DH, CM), Department of Cardiovascular Sciences, KU Leuven University campus Kulak, Kortrijk, Belgium Kortrijk Campus, Kortrijk, Belgium (DH, CM), National Trauma Research Institute, Alfred Health & Monash University (DH, MCF), Trauma Service, The Alfred Hospital, Melbourne, Victoria, Australia (MCF), Institute for Research in Operative Medicine (IFOM), Universität Witten/Herdecke, Cologne, Germany (RL), Department of Emergency Medicine, UZ Leuven Hospital, (SV), Department of Public Health and Primary Care, KU Leuven University, Leuven, Belgium (SV), Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU).
• Eur J Anaesthesiol. 2023 Nov 1; 40 (11): 865873865-873.

BackgroundUp to 25% of trauma deaths are related to thoracic injuries.ObjectiveThe primary goal was to analyse the incidence and time distribution of death in adult patients with major thoracic injuries. The secondary goal was to determine if potentially preventable deaths occurred within this time distribution and, if so, identify an associated therapeutic window.DesignRetrospective observational analysis.SettingTraumaRegister DGU.PatientsMajor thoracic injury was defined as an Abbreviated Injury Scale (AIS) 3 or greater. Patients with severe head injury (AIS ≥ 4) or injuries to other body regions with AIS being greater than the thoracic injury (AIS other >AIS thorax) were excluded to ensure that the most severe injury described was primarily thoracic related.Main Outcome MeasuresIncidence and time distribution of mortality were considered the primary outcome measures. Patient and clinical characteristics and resuscitative interventions were analysed in relation to the time distribution of death.ResultsAmong adult major trauma cases with direct admission from the accident scene, 45% had thoracic injuries and overall mortality was 9.3%. In those with major thoracic trauma ( n  = 24 332) mortality was 5.9% ( n  = 1437). About 25% of these deaths occurred within the first hour after admission and 48% within the first day. No peak in late mortality was seen. The highest incidences of hypoxia and shock were seen in non-survivors with immediate death within 1 h and early death (1 to 6 h). These groups received the largest number of resuscitative interventions. Haemorrhage was the leading cause of death in these groups, whereas organ failure was the leading cause of death amongst those who survived the first 6 h after admission.ConclusionAbout half of adult major trauma cases had thoracic injuries. In non-survivors with primarily major thoracic trauma, most deaths occurred immediately (<1h) or within the first 6 h after injury. Further research should analyse if improvements in trauma resuscitation performed within this time frame will reduce preventable deaths.Trial RegistrationThe present study is reported within the publication guidelines of the TraumaRegister DGU® and registered as TR-DGU project ID 2020-022.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology and Intensive Care.

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