Timing of trauma deaths due to uncontrolled bleeding have not changed in three decades: A multicenter study of patients in hemorrhagic shock

Introduction: Hemorrhage is the major cause of early, preventable trauma deaths. We provide a contemporary(2018–2021) description of deaths of patients at risk for lethal traumatic hemorrhage admitted to seven trauma centers equipped with the most advanced hemostatic therapies. Methods: This is a secondary analysis of non-survivors of the multicenter SWAT study, which enrolled patients at high-risk for life-threatening hemorrhage(age>15yrs, required blood ​+ ​surgical/embolization hemorrhage control procedures<1 ​h; penetrating head injury and >5min CPR were excluded. Causes of death(COD) were prospectively adjudicated by the SWAT team of trauma surgeons. Results: Of 1051 patients, 176(16.7 ​%) died(74 ​% ​< ​24 ​h,56 ​%<6 ​h,35 ​%<3 ​h). Bleeding was the main COD, occurring mostly <3 ​h. Over one third of these patients had a TRISS estimated survival probability>50 ​%. TBI was the COD in 10 ​% of the deaths(TRISS ​= ​8 ​%), mostly 12–48 ​h. The third COD was organ failure, in 9 ​%(TRISS ​= ​25 ​%), often >48 ​h. Conclusion: Uncontrolled bleeding in patients with high probability of survival remains a challenge to reduce preventable trauma deaths.