Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 30;15(1):55.
doi: 10.1186/s13017-020-00330-3.

Global changes in mortality rates in polytrauma patients admitted to the ICU-a systematic review

Johanna M M van Breugel  1 , Menco J S Niemeyer  2 , Roderick M Houwert  2 , Rolf H H Groenwold  3 , Luke P H Leenen  2 , Karlijn J P van Wessem  2
Affiliations

Global changes in mortality rates in polytrauma patients admitted to the ICU-a systematic review

Johanna M M van Breugel et al. World J Emerg Surg. .

Abstract

Background: Many factors of trauma care have changed in the last decades. This review investigated the effect of these changes on global all-cause and cause-specific mortality in polytrauma patients admitted to the intensive care unit (ICU). Moreover, changes in trauma mechanism over time and differences between continents were analyzed.

Main body: A systematic review of literature on all-cause mortality in polytrauma patients admitted to ICU was conducted. All-cause and cause-specific mortality rates were extracted as well as trauma mechanism of each patient. Poisson regression analysis was used to model time trends in all-cause and cause-specific mortality. Thirty studies, which reported mortality rates for 82,272 patients, were included and showed a decrease of 1.8% (95% CI 1.6-2.0%) in all-cause mortality per year since 1966. The relative contribution of brain injury-related death has increased over the years, whereas the relative contribution of death due to multiple organ dysfunction syndrome (MODS), acute respiratory distress syndrome, and sepsis decreased. MODS was the most common cause of death in North America, and brain-related death was the most common in Asia, South America, and Europe. Penetrating trauma was most often reported in North America and Asia.

Conclusions: All-cause mortality in polytrauma patients admitted to the ICU has decreased over the last decades. A shift from MODS to brain-related death was observed. Geographical differences in cause-specific mortality were present, which may provide region-specific learning possibilities resulting in improvement of global trauma care.

Keywords: Intensive care unit; Mortality; Polytrauma patients; Trauma care.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests

Figures

Fig. 1
Fig. 1
PRISMA flowchart of search, screening, and inclusion strategy
Fig. 2
Fig. 2
Changes in all-cause mortality in polytrauma patients admitted to the ICU since 1966. Each study is represented by a circle, of which the size is proportional to the number of subjects in the study
Fig. 3
Fig. 3
Relative contribution of cause-specific mortality to all-cause mortality in polytrauma patients admitted to the ICU since 1966. Different panels show the relative contribution of different causes of death
Fig. 4
Fig. 4
a Geographical differences in trauma mechanism divided in blunt and penetrating trauma between North America, Asia, Oceania, and Europe. North America showed the highest percentage of penetrating injuries, while Europe has the most blunt injuries. b Cause of mortality per continent. MODS was most prevalent in North America, hemorrhage in Asia, and brain injury in Europe
See this image and copyright information in PMC

References

    1. World Health Organisation, Health topics - injury, 2014.
    1. Lansink KW, Gunning AC, Spijkers AT, et al. Evaluation of trauma care in a mature level I trauma center in the Netherlands: outcomes in a Dutch mature level I trauma center. World J Surg. 2013;37:2353–2359. doi: 10.1007/s00268-013-2103-9. - DOI - PubMed
    1. Pfeifer R, Tarkin IS, Rocos B, et al. Patterns of mortality and causes of death in polytrauma patients--has anything changed? Injury. 2009;40:907–911. doi: 10.1016/j.injury.2009.05.006. - DOI - PubMed
    1. Baker CC, Oppenheimer L, Stephens B, et al. Epidemiology of trauma deaths. Am J Surg. 1980;140:144–150. doi: 10.1016/0002-9610(80)90431-6. - DOI - PubMed
    1. Trunkey DD. 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. 1983;249:28–35. doi: 10.1038/scientificamerican0883-28. - DOI - PubMed

Publication types