Autor:
Dr.
Elias J. Ilias
Brasil |
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CAUSES OF DEATH AND EPIDEMIOLOGIC
PROFILE OF TRAUMATIC DEATHS IN THE
FIRST TWENTY FOUR HOURS AFTER TRAUMA
AT GRAJAU GENERAL HOSPITAL –
UNIVERSITY OF SANTO AMARO
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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.
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