Introduction and Objectives

Trauma remains the leading cause of deaths in young patients. Injury prevention is critical to further significantly reduce the toll of death and disability caused by trauma.

The purpose of this work was to evaluate the causes of traumatic death registered at the first twenty four hours after trauma, in patients admitted at the emergency service of Grajau General Hospital (São Paulo), and evaluate the epidemiologic profile, injuried organs and anatomic areas  involved, looking for parameters for orientation in attendance of trauma victims. 

Materials and Methods

In this retrospective study were included all deaths registered at Grajau General Hospital (FM-UNISA) from January, first, 2002 to December 31, 2003.

The patient records at Grajau General Hospital were raised, as well as the oficial necropsia reports, conceded by São Paulo Legal Medicine Institute (IML).

Only traumatic deaths registered in the first 24 hours after trauma were analysed in this study, being excluded the other cases and those with incomplete documentation at the hospital or IML records.

These records were analysed according the following parameters: gender, age, race, marital status, profession, date and time of admisson, anatomic areas involved (divided in: head and neck, thorax, abdomen, pelvis, upper limbs and lower limbs), injuried organs, death causes and nature of trauma.

Results

During the period of the study, there were 2204 deaths at Grajau General Hospital at all clinics,  about 15% (n=326) had a traumatic cause. Deaths at the first 24 hours of trauma corresponded to 89% of all trauma deaths (n=290). Of the total of the 290 cases, 63 were excluded for the reasons described in the method.

Of the 227 trauma deaths at the first 24 hours, 86.8% (n=197) were caused by penetrating trauma, with prevalence of gunshot wounds, 12% caused by blunt trauma, and the rest for other causes.

From all trauma cases, 75.7% were admitted already dead, being the rest submitted to some medical procedure before death.

Most of cases were in men, in a 15:1 proportion. The average age of the patients was 28 years. The white patients represented 52% of all, folowed by 6% of blacks and 42% of mixed race. Most of cases were admitted in the emergency service between 06:00 and 12:00 pm.

Most patients were single, in a 4:1 proportion to married. Employed patients corresponded to 69% of cases, 14% were unemployed and 9% students.

The major cause of trauma death was acute traumatic internal bleeding (38%), folowed by brain injury (27%) and an association of both (12%).

The anatomic areas were involved in the following proportion: head and neck 67%, thorax 65%, abdomen 48%, pelvis 4%, upper limbs 8% and lower limbs 6%.

The most injuried organ was encephalus (n=103), corresponding to 45,3% of the patients, followed by lung (n=92), bowel (n=66), heart (n=48) and liver (n=48).

Discussion and Conclusion

Trauma is an important death cause at the area of the study, corresponding to almost 15% of the total  deaths at Grajau General Hospital. The gunshot wounds were responsible for the most cases of death in the first 24 hours after trauma, representing about 85% of deaths. Due to the nature of injuries and the huge number of patients admitted at the hospital already dead, measures like increase the public security and the disarmament of population can be considered important methods to reduce the number of trauma deaths.