Peak of Mortality

Peak of Mortality

Trauma also known as injury can be defined as a "physical harm or damage to the structure or function of the body, caused by an acute exchange of energy (mechanical, chemical, thermal, radioactive, or biological) that exceeds the body's tolerance".

The mortality due to injury occurs during one of the following time periods.

The first peak of death occurs at the time of the injury. It may be instantaneous or within the first few minutes and is due to overwhelming primary injury to major organs or structures such as brain, heart or great vessels. In most situations these injuries are irrecoverable, although rapid treatment and transfer may salvage some patients. Primary prevention has a major role in reducing the incidence of these injuries.

The second peak lasts from the end of this first period to several hours after the injury has taken place. It is during this time that many causes of morbidity and mortality are preventable by avoidance of a secondary injury due to hypoxia, hemorrhage or any process that leads to inadequate tissue perfusion. Reversible conditions may include intracranial hematomas, major hemorrhage from viscera, bones and vessels or pneumothorax. Most trauma care is directed at this period as skilled assessment and treatment should reduce mortality and disability. Even with moderate facilities many lives can be saved by simple measures.

Even beyond this first hour, delays in diagnosis or treatment lead to increased morbidity and mortality rates. The immediate goals in trauma care are therefore to keep the patient alive, identify life-threatening injuries, stop any ongoing bleeding and complete definitive treatment as early as possible.

The third peak of death occurs days or weeks after the injury and usually happens in a high dependency area where sepsis and multiple organ failure ensue. Advances in intensive care treatment may reduce these deaths but improvements in initial management on admission will also reduce morbidity and mortality during this period.

Last modified: Sunday, 20 November 2016, 9:20 AM