World Journal of Surgery

, Volume 36, Issue 9, pp 2125–2130 | Cite as

Overall Distribution of Trauma-related Deaths in Berlin 2010: Advancement or Stagnation of German Trauma Management?

  • Christian Kleber
  • Moritz T. Giesecke
  • Michael Tsokos
  • Norbert P. Haas
  • Klaus D. Schaser
  • Poloczek Stefan
  • Claas T. Buschmann



Trauma is the leading cause of death among children, adolescents, and young adults. The latest data from the German Trauma Registry reveals a constant decrease in trauma mortality, indicating that 11.6 % of all trauma patients in 2010 died in hospital. Notably, trauma casualties dying before admission to hospital have not been systematically surveyed and analyzed in Germany.


We conducted a prospective observational study of all traumatic deaths in Berlin, recording demographic data, trauma mechanisms, and causes/localization and time of death after trauma. Inclusion criteria were all deaths following trauma from 1 January 2010 to 31 December 2010.


A total of 440 trauma fatalities were included in this study, with a mortality rate of 13/100,000 inhabitants; 78.6 % were blunt injuries, and fall from a height >3 m (32.7 %) was the leading trauma mechanism. 32.5 % died immediately, 23.9 % died within 60 min, 7.7 % died within 1–4 h, 16.8 % died within 4–48 h, 11.1 % died <1 week later, and 8 % died >1 week after trauma. The predominant causes of death were polytrauma (45.7 %), sTBI (38 %), exsanguination (9.5 %), and thoracic trauma (3.2 %). Death occurred on-scene in 58.7 % of these cases, in the intensive care unit in 33.2 %, and in 2.7 % of the cases, in the emergency department, the operating room, and the ward, respectively.


Polytrauma is the leading cause of death, followed by severe traumatic brain injury (sTBI). The temporal analysis of traumatic death indicates a shift from the classic “trimodal” distribution to a new “bimodal” distribution. Besides advances in road safety, prevention programs and improvement in trauma management—especially the pre-hospital phase—have the potential to significantly improve the survival rate after trauma.


Death Certificate Severe Traumatic Brain Injury Road Safety Trauma Mechanism Thoracic Trauma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Contributions were made possible by DFG funding through the Berlin-Brandenburg School for Regenerative Therapies GSC 203.

Conflict of interest



  1. 1.
    Buschmann CT, Gahr P, Tsokos M et al (2010) Clinical diagnosis versus autopsy findings in polytrauma fatalities. Scand J Trauma Resusc Emerg Med 18:55PubMedCrossRefGoogle Scholar
  2. 2.
    Pfeifer R, Tarkin IS, Rocos B et al (2009) Patterns of mortality and causes of death in polytrauma patients—has anything changed? Injury 40:907–911PubMedCrossRefGoogle Scholar
  3. 3.
    Trunkey DD (1983) Trauma. Accidental and intentional injuries account for more years of life lost in the U.S. than cancer and heart disease. Among the prescribed remedies are improved preventive efforts, speedier surgery and further research. Sci Am 249:28–35PubMedCrossRefGoogle Scholar
  4. 4.
    Sauaia A, Moore FA, Moore EE et al (1995) Epidemiology of trauma deaths: a reassessment. J Trauma 38:185–193PubMedCrossRefGoogle Scholar
  5. 5.
    Probst C, Zelle BA, Sittaro NA et al (2009) Late death after multiple severe trauma: when does it occur and what are the causes? J Trauma 66:1212–1217PubMedCrossRefGoogle Scholar
  6. 6.
    Evans JA, van Wessem KJ, McDougall D et al (2010) Epidemiology of traumatic deaths: comprehensive population-based assessment. World J Surg 34:158–163. doi: 10.1007/s00268-009-0266-1 PubMedCrossRefGoogle Scholar
  7. 7.
    Probst C, Pape HC, Hildebrand F et al (2009) 30 years of polytrauma care: an analysis of the change in strategies and results of 4849 cases treated at a single institution. Injury 40:77–83PubMedCrossRefGoogle Scholar
  8. 8.
    Haas NP, Hoffmann RF, Mauch C et al (1995) The management of polytraumatized patients in Germany. Clin Orthop Relat Res 318:25–35PubMedGoogle Scholar
  9. 9.
    Baker CC, Oppenheimer L, Stephens B et al (1980) Epidemiology of trauma deaths. Am J Surg 140:144–150PubMedCrossRefGoogle Scholar
  10. 10.
    Mock CN, Jurkovich GJ, nii-Amon-Kotei D et al (1998) Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma 44:804–812 discussion 812–804PubMedCrossRefGoogle Scholar
  11. 11.
    Demetriades D, Murray J, Sinz B et al (1998) Epidemiology of major trauma and trauma deaths in Los Angeles County. J Am Coll Surg 187:373–383PubMedCrossRefGoogle Scholar
  12. 12.
    Masella CA, Pinho VF, Costa Passos AD et al (2008) Temporal distribution of trauma deaths: quality of trauma care in a developing country. J Trauma 65:653–658PubMedCrossRefGoogle Scholar
  13. 13.
    Potenza BM, Hoyt DB, Coimbra R et al (2004) The epidemiology of serious and fatal injury in San Diego County over an 11-year period. J Trauma 56:68–75PubMedCrossRefGoogle Scholar
  14. 14.
    Spain DM, Fox RI, Marcus A (1984) Evaluation of hospital care in one trauma care system. Am J Public Health 74:1122–1125PubMedCrossRefGoogle Scholar
  15. 15.
    Daly KE, Thomas PR (1992) Trauma deaths in the south west Thames region. Injury 23:393–396PubMedCrossRefGoogle Scholar
  16. 16.
    Maio RF, Burney RE, Gregor MA et al (1996) A study of preventable trauma mortality in rural Michigan. J Trauma 41:83–90PubMedCrossRefGoogle Scholar
  17. 17.
    Chiara O, Scott JD, Cimbanassi S et al (2002) Trauma deaths in an Italian urban area: an audit of pre-hospital and in-hospital trauma care. Injury 33:553–562PubMedCrossRefGoogle Scholar
  18. 18.
    Kleber C, Lefering R, Kleber AJ et al (2012) Rescue time and survival of severely injured patients in Germany. UnfallchirurgGoogle Scholar
  19. 19.
    MacLeod JB, Cohn SM, Johnson EW et al (2007) Trauma deaths in the first hour: are they all unsalvageable injuries? Am J Surg 193:195–199PubMedCrossRefGoogle Scholar
  20. 20.
    Kleber C, Schaser KD, Haas NP (2011) Surgical intensive care unit—the trauma surgery perspective. Langenbecks Arch Surg 396:429–446PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Christian Kleber
    • 1
  • Moritz T. Giesecke
    • 1
  • Michael Tsokos
    • 2
  • Norbert P. Haas
    • 1
  • Klaus D. Schaser
    • 1
  • Poloczek Stefan
    • 3
  • Claas T. Buschmann
    • 2
  1. 1.Center for Musculoskeletal Surgery, AG PolytraumaCharité—UniversitätsmedizinBerlinGermany
  2. 2.Institute of Legal Medicine and Forensic SciencesCharité—UniversitätsmedizinBerlinGermany
  3. 3.Berlin Fire DepartmentBerlinGermany

Personalised recommendations