Epidemiology of Trauma Deaths: Volume, Methodology, and Comparability—Reply to Letter

Abstract

We are thankful for the insightful comments on our prospective population-based epidemiological study on traumatic deaths in our trauma system (John Hunter Hospital, New South Wales, Australia) [1]. Our study evaluated the first year of our trauma center/trauma system after the establishment of the new trauma service and concluded the challenge of an aging population; the potential relative increase of hemorrhage related deaths in high-energy trauma and warned about the growing problem of lowenergy fall related deaths. We are well aware of the Professor Soreide’s 9-year retrospective evaluation of 260 trauma autopsies from Norway [2]. We strongly agree with the concept that geographical location and different time points of assessment are, not surprisingly, leading to different results. These two reasons influenced our study design. First, we wanted to describe the epidemiology of traumatic deaths in a comprehensive (highand low-energy) prospective fashion, including all inhospital and prehospital trauma deaths, which has not been done in Australia before. Second, considering the rapid change in the delivery of trauma care (especially in a young trauma system), we insisted to a 12-month prospective study similar to the studies that we considered landmark papers [3–5]. We believe more frequent comparison of shorter periods (12 months) are potentially more meaningful than lumping many years of data together from relatively low volume centers. Our study described 103 trauma fatalities in 1 year, whereas the Stavanger University Hospital 9-year experience was 260 fatalities (29 trauma deaths per year). Their severely injured (ISS [15) is 80–85 patients/year, whereas the John Hunter Hospital admits alone 400–420 patients in the same category annually. We do not feel that the two trauma systems are highly comparable. However, we are convinced that the SUH standards of trauma care are very different today compared with 1996 when their 9 years retrospective study started. Hopefully, we will be able to document similar improvements in our trauma system. We reported both low-energy and high-energy traumatic deaths, because our trauma center and system is committed to address the often very distinct requirements of these two patient populations. This did not prevent us from publishing both high-energy (12.3/100,000/year) and low-energy (8.6/100,000/year) incidence separately to allow comparisons with other population based studies. Our study design, detailed in the Methods section, explicitly excluding asphyxia without injuries: ‘‘Deaths related to electrocution, drowning, hanging asphyxiation, strangling, and poisoning were excluded from the data analysis.’’ We also agree with the potential misinterpretation of temporal patterns of the epidemiology of trauma deaths in many communications. To avoid this bias our study design (time frames and categories of deaths) followed the previous studies referred to the trimodal death distribution. Again, our study was a baseline description of the epidemiology of traumatic deaths in our young trauma system. Some of the authors of this study have firsthand experience of the European, North American, and Australian trauma care, which might eliminate some of the uncertainties of comparing different trauma systems. We definitively agree with the letter that longitudinal Z. J. Balogh (&) J. A. Evans Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, Australia e-mail: Zsolt.Balogh@hnehealth.nsw.gov.au