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The differential survival of trauma patients.

Advances in prehospital care and the development of regionalized trauma centers have reduced the mortality from major trauma. However, patients who have sustained severe brain injuries (Glasgow Coma Score less than or equal to 8) treated in such a setting still have a substantial mortality. In order to determine if mortality is a function of severe brain injury, 545 trauma patients with and without severe brain injury were prospectively studied. All patients were similarly treated by one medical center from the actual site of injury until discharge from the hospital. There were 104 patients who had sustained major blunt trauma with severe brain injury and 441 patients who had sustained major blunt trauma without severe brain injury. The mortality of the former group was 30.8%, whereas that of the latter group was 0.9% (p less than 0.0001).