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World Journal of Surgery

, Volume 41, Issue 7, pp 1790–1795 | Cite as

Population-Based Autopsy Study of Traumatic Fatalities

  • S. Saar
  • A. Lomp
  • J. Laos
  • V. Mihnovitš
  • R. Šalkauskas
  • T. Lustenberger
  • M. Väli
  • U. Lepner
  • P. Talving
Original Scientific Report

Abstract

Background

Injuries result in 5.8 million global fatalities annually and are the leading cause of death in younger individuals. Nevertheless, population-based autopsy investigations on traumatic deaths are scarce. We set out to study all consecutive autopsies on traumatic fatalities performed in a 5-year time segment in Estonia.

Methods

After the ethics review board approval, all consecutive autopsies after blunt or penetrating deaths occurring in prehospital or in-hospital settings between January 1, 2009, and December 31, 2013, were retrospectively reviewed using the National Forensic Medicine Database. Fatalities due to suffocation, intoxication, burns, or freezing were excluded. Data collection included demographics, mechanism of injuries, cause of death, and a detailed injury profile. Primary outcome was cause of death. Secondary outcomes included injury patterns.

Results

Overall, 1344 autopsies were included. 75.7% of deaths were following blunt trauma. Mean age was 50.4 ± 18.5 years, and 77.1% were male. A total of 71.8% of deaths occurred in the prehospital setting. Accidents, assaults, and suicides constituted 64.4, 20.5, and 15.2% of deaths, respectively. A total of 51.1% of injury fatalities had a positive blood alcohol level (BAL). Mean injury severity score was 39.7 ± 23.9. Most common cause of death was due to head injuries at 50.5% followed by hemorrhage at 30.4%. Cardiac and aortic injuries were the predominant cause of hemorrhage-related fatalities.

Conclusions

The current population-based investigation documented brain injury as the predominant cause of death followed by cardiac and aortic injuries. High incidence of positive BAL among injury fatalities requires national initiatives for alcohol harm reduction and law enforcement efforts.

Keywords

Blunt Trauma Pelvic Fracture Aortic Injury Fatal Injury Blood Alcohol Level 
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.

Notes

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no conflict of interest.

References

  1. 1.
    World Health Organization (WHO) Violence and injury prevention. http://www.who.int/violence_injury_prevention/key_facts/en/. Accessed 29 May 2016
  2. 2.
    Centers for Disease Control and Prevention (2011) Injury prevention and control: data and statistics. http://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2011-a.pdf. Accessed 29 Oct 2014
  3. 3.
    Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G (2003) SCCM/ESICM/ACCP/ATS/SIS. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 31(4):1250–1256CrossRefPubMedGoogle Scholar
  4. 4.
    Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ (1995) Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 23(10):1638–1652CrossRefPubMedGoogle Scholar
  5. 5.
    Shackford SR, Mackersie RC, Holbrook TL, Davis JW, Hollingsworth-Fridlund P, Hoyt DB, Wolf PL (1993) The epidemiology of traumatic death. A population-based analysis. Arch Surg 128(5):571–575CrossRefPubMedGoogle Scholar
  6. 6.
    He M, Fang YX, Lin JY, Ma KJ, Li BX (2015) Unnatural deaths in Shanghai from 2000 to 2009: a retrospective study of forensic autopsy cases at the Shanghai Public Security Bureau. PLoS ONE 10(6):e0131309CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Demetriades D, Murray J, Sinz B, Myles D, Chan L, Sathyaragiswaran L, Noguchi T, Bongard FS, Cryer GH, Gaspard DJ (1998) Epidemiology of major trauma and trauma deaths in Los Angeles County. J Am Coll Surg 187(4):373–383CrossRefPubMedGoogle Scholar
  8. 8.
    Sharma G, Shrestha PK, Wasti H, Kadel T, Ghimire P, Dhungana S (2006) A review of violent and traumatic deaths in Kathmandu, Nepal. Int J Inj Contr Saf Promot 13(3):197–199CrossRefPubMedGoogle Scholar
  9. 9.
    Postimees (2005–2015) ohvriterohkeimad liiklusõnnetused ja nende põhjused. http://arvamus.postimees.ee/3285211/2005-2015-ohvriterohkeimad-liiklusonnetused-ja-nende-pohjused?_ga=1.135749749.536610908.1482156890. Accessed 26 Dec 2016
  10. 10.
    Traffic act. Riigi Teataja (2013). https://www.riigiteataja.ee/en/compare_original?id=507012014005. Accessed 28 Dec 2016
  11. 11.
    Teixeira PG, Georgiou C, Inaba K, Dubose J, Plurad D, Chan LS, Toms C, Noguchi TT, Demetriades D (2009) Blunt cardiac trauma: lessons learned from the medical examiner. J Trauma 67(6):1259–1264CrossRefPubMedGoogle Scholar
  12. 12.
    Campbell NC, Thomson SR, Muckart DJ, Meumann CM, Van Middelkoop I, Botha JB (1997) Review of 1198 cases of penetrating cardiac trauma. Br J Surg 84(12):1737–1740CrossRefPubMedGoogle Scholar
  13. 13.
    Shackelford S, Nguyen L, Noguchi T, Sathyavagiswaran L, Inaba K, Demetriades D (2011) Fatalities of the 2008 Los Angeles train crash: autopsy findings. Am J Disaster Med 6(2):127–131PubMedGoogle Scholar
  14. 14.
    Dosios TJ, Salemis N, Angouras D, Nonas E (2000) Blunt and penetrating trauma of the thoracic aorta and aortic arch branches: an autopsy study. J Trauma 49(4):696–703CrossRefPubMedGoogle Scholar
  15. 15.
    Balogh Z, King KL, Mackay P, McDougall D, Mackenzie S, Evans JA, Lyons T, Deane SA (2007) The epidemiology of pelvic ring fractures: a population-based study. J Trauma 63(5):1066–1073CrossRefPubMedGoogle Scholar
  16. 16.
    EuroSafe (2013) Injuries in the European Union. Report on injury statistics 2008–2010. AmsterdamGoogle Scholar
  17. 17.
    Eurosafe (2014) Injuries in the European Union. Report on injury statistics 2010–2012. AmsterdamGoogle Scholar
  18. 18.
    Eurosafe (2016) Injuries in the European Union. Report on injury statistics 2012–2014. AmsterdamGoogle Scholar
  19. 19.
    Statistics Estonia (2016). https://www.stat.ee/75540. Accessed 26 Dec 2016
  20. 20.

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • S. Saar
    • 1
    • 2
  • A. Lomp
    • 1
  • J. Laos
    • 1
    • 2
  • V. Mihnovitš
    • 1
  • R. Šalkauskas
    • 1
    • 3
  • T. Lustenberger
    • 4
  • M. Väli
    • 1
    • 5
  • U. Lepner
    • 1
    • 3
  • P. Talving
    • 1
    • 2
    • 3
  1. 1.School of MedicineUniversity of TartuTartuEstonia
  2. 2.Division of Acute Care Surgery, Department of SurgeryNorth Estonia Medical CenterTallinnEstonia
  3. 3.Department of SurgeryTartu University HospitalTartuEstonia
  4. 4.Division of TraumaGoethe University HospitalFrankfurtGermany
  5. 5.Department of Pathological Anatomy and Forensic MedicineUniversity of TartuTartuEstonia

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