Epidemiology of severe trauma in Navarra for 10 years: out-of-hospital/ in-hospital deaths and survivors

BACKGROUND: Major trauma is a leading cause of death. Due to the difficulties to keep a registry of these cases, few studies include all subjects, because they exclude out-of-hospital deaths. The purpose of this work was to compare the epidemiological profiles of out-of-hospital deaths, in-hospital deaths, and survivors over a 10-year period (2010–2019) of patients who had been treated by Navarre´s Health Service (Spain). METHODS: Retrospective longitudinal cohort study using data of patients injured by an external physical force of any intentionality and with a New Injury Severity Score above 15. Hangings, drownings, burns, and chokings were excluded. Intergroup differences of demographic and clinical variables were analysed using the Kruskal Wallis test, chi-squared test, or Fisher´s exact test. RESULTS: Data from 2,610 patients were analysed; 624 died out-of-hospital, 439 in-hospital, and 1,547 survived. Trauma incidences remained moderately stable over the 10-year period analysed, with a slight decrease in out-of-hospital deaths and a slight increase in in-hospital deaths. Patients of the out-of-hospital deaths group were younger (50.9 years) in comparison to in-hospital deaths and survivors. Death victims were predominantly male in all study groups. Intergroup differences regarding prior comorbidities and predominant type of injury were observed. CONCLUSIONS: There are significant differences among the three study groups. More than half of the deaths occur out-of-hospital and the causative mechanisms differ in each of them. Thus, when designing strategies, preventive measures were considered for each group on a case-by-case basis.