Trauma related deaths typically demonstrate a tri-modal distribution:

• Initial mortality, within 30 min of the traumatic event, (e.g. great vessel rupture, gross cerebral disruption) constitutes 50–60% of all trauma-related deaths.

• 30% constitute deaths within 4 h — usually due to considerable volume loss compounded by ventilatory failure.

• The remainder constitute mortality in the days/weeks following the initial event and is typically due to a combination of multi-organ failure and sepsis.

The notion of “The Golden Hour” suggests active resuscitation within the first hour of trauma impacts positively on mortality.

Epidemiology of trauma

In the UK:

• Trauma cases occupy 850,000 bed nights (Average hospital stay 10–12 days).

• 0.5–1.0 major trauma cases/1000 population/year.

• 75% major trauma cases admitted between 5 p.m. and 8 a.m. (80% <45 years).

• Males constitute 72% of trauma related deaths and 56% of non-fatal injuries.

• Road traffic accidents (RTA) are a major cause of trauma mortality (in the USA, mortality from RTA accounts for 40% of total trauma mortality).

• UK has the highest paediatric RTA rate in the world.

Trauma death rates per million of population/per annum:

• UK 88/18,000.

• US 111/165,000.

Trauma is the third commonest cause of death in all age groups (UK and US) and the commonest cause of death in <45-year-old age group.