Damage Control Laparotomy (DCL) Trial
In 2013, injuries accounted for 59% of all deaths among people ages 1-45 years.[i] There were more than 192,900 deaths from injury, approximately one every 3 minutes. Since trauma is a disease of the young, these deaths also account for the most life-years lost of any other disease – 30% of all life years lost in the U.S. compared to cancer 16% and heart disease 12%.[ii]
In 1983, the distribution of deaths had a trimodal distribution. In this construct, immediate deaths were considered to be those within hours of injury. Efforts to decrease the number of immediate deaths focused on trauma prevention (speed limits, helmet laws, seat belts, to name a few).
[TRUNKEY DD FIGURE]
Early deaths were thought to be those who survived the pre-hospital transport to a trauma center. These deaths occurred in the hospital and were mainly due to hemorrhage or traumatic brain injury.
Late deaths occur weeks after injury and are thought to be due to infection and organ failure. A significant amount of time and resources have been invested in the prevention of these late deaths, including advances in nutrition, ventilator management, and treatment of sepsis. The result of this investment has been a transition from a trimodal distribution of death to a bimodal distribution of death without a late peak.
Compared to the significant resources poured into the prevention of late deaths, rigorous studies of interventions to prevent early death have lacked. One major difficulty in the rigorous study of emergent interventions is the general inability to obtain informed consent from participants who require an emergency intervention.
[i] Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Injury Prevention and Control [online]. Accessed September 20, 2015
[ii] Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. Accessed September 20, 2015.