Training to identify red flags in the acute care of trauma: who are the patients at risk for early death despite a relatively good prognosis? An analysis from the TraumaRegister DGU

Background In the acute care of trauma, some patients with a low estimated risk of death die suddenly and unexpectedly. In this study, we aim to identify predictors for early death within 24 h following hospital admission in low-risk patients. Methods The TraumaRegister DGU[R] was used to collect records of patients who were primarily treated in a participating hospital between 2004 and 2013 with a RISC II score below 10%. Results During the study period, 64,379 patients met the inclusion criteria. The mean RISC II score was 2.0%, and the mean ISS was 16 [+ or -] 9. The overall hospital mortality rate was 2.1%, and 0.5% of patients (n = 301) died within the first 24 h. A SPB of [less than or equai to] 90 mmHg was associated with an increased risk of death (p < 0.001). An AIS abdomen score of [greater than or equai to] 3 was associated with increased risk of death within the first 24 h (p < 0.001). A high risk of early death was also seen in patients with an AIS score (thorax) [greater than or equai to] 3; 51% of those who died died within the first 24 h (p < 0.005). Death in patients over 60 years was more common after 24 h (p < 0.001). Patients with an ASA score of [greater than or equai to] 3 were more likely to die after the first 24 h (p < 0.001). Conclusions Indicators predicting a high risk of early death in patients with a low RISC II score include a SPB [less than or equai to] 90 mmHg and severe chest and abdominal trauma. Emergency teams involved in the acute care of trauma patients should be aware of these "red flags" and treat their patients accordingly. Keywords: Trauma, Revised injury severity classification (RISC-score), Trauma registry, Early death, Red flags, Prehospital, Life support