By Christina Frangou
Trauma centers in the United States are experiencing a major shift in the most common causes of trauma-related fatalities—changes that may necessitate new strategies for trauma prevention and treatment, according to experts.
A new study showed that, if current trends continue, falls would soon account for more deaths than either motor vehicle collisions or firearms.
“This fact poses an interesting public health challenge, namely, preventing falls in the elderly,” said Christopher C. Baker, MD, chair of surgery at the Carilion Clinic in Roanoke, Va. He was the official discussant of the paper when it was presented at the opening session of the 2013 annual meeting of the American Association for the Surgery of Trauma (AAST).
The study showed that, since 2002, deaths due to motor vehicle collisions have declined by 27% due to improvements in car safety, public awareness and medical care. But that drop has been offset by a marked increase in fatalities related to falls, the rate of which rose by 46% over an eight-year period.
“It’s clear that the mix of injuries that are currently being seen are substantially different than 10 years ago,” said primary investigator Kristan L. Staudenmayer, MD, MS, assistant professor of surgery in trauma and critical care at Stanford University, Stanford, Calif.
Overall, total trauma-related mortality decreased by 6% between the years 2002 and 2010 (P<0.01). The drop occurred despite an increase in the number of miles driven by Americans and a 10% increase in the number of firearm injuries.
Researchers from Stanford examined different data sources for the years ranging from 2002 to 2010: The American College of Surgeons’ National Trauma Data Bank and the Centers for Disease Control and Prevention’s (CDC) National Center for Injury Prevention and Control and its Web-based Injury Statistics Query and Reporting System (WISQARS). The researchers used the Cochran–Armitage test for trend to analyze mortality trends by year.
In 2002, motor vehicle collisions caused about 16 deaths per 100,000 people living in the United States. In the same year, falls caused only about six deaths per 100,000 people. But by 2010, the picture changed markedly. Falls caused almost nine deaths per 100,000 people, whereas motor vehicle deaths had fallen to 12 per 100,000.
Deaths from firearms stayed relatively stable between 2002 and 2010 at 10 per 100,000. Firearm injuries were seen more frequently in hospitals, increasing from a reported 31 to 34 per 100,000 people.
The study was not designed to examine variables like patient frailty or age. Even so, the results strongly suggested that the demographics of patients arriving in trauma bays have changed. Today, trauma patients are older and sicker than a decade ago.
Dr. Staudenmayer said the changing demographics of patients needs to be taken into account when apportioning future trauma resources and creating prevention strategies.
“The big challenge is that we are going to be dealing with patients who are more frail and have more comorbidities. That’s going to mean that we have to provide not just surgical care, but increasingly more medical care to these patients,” Dr. Staudenmayer said.
“As our population ages, we’re going to have to adjust our resources appropriately and keep close tabs on the trends in trauma-related mortality so we can continue to calibrate our resources against the needs of the population,” she added.
The study confirmed earlier reports that deaths from motor vehicle collisions occur less frequently. Accidents that resulted in injuries also declined, with fewer injuries per accident in 2010 compared with 2002.
This study was the first analysis of national trauma trends using these multiple data sources and the first analysis of its kind that depicted what trauma surgeons are seeing in their emergency rooms.
Experts noted that the study had several significant limitations. The study investigators made comparisons across four different data sets, but each data set had its own limitations and methodologies. Moreover, investigators could not identify the number of patients who did not seek or receive treatment, nor could they discern the frailty of patients before injury.
Deaths from burns, drowning, poisoning, suffocation and adverse effects were excluded from the study.
This year marked the 75th anniversary of the AAST Annual Meeting.