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The epidemiology of trauma-related mortality in the United States from 2002 to 2010

Sise, Robert G. MBA, MPH; Calvo, Richard Y. PhD(c); Spain, David A. MD; Weiser, Thomas G. MD, MPH; Staudenmayer, Kristan L. MD, MS

Journal of Trauma and Acute Care Surgery: April 2014 - Volume 76 - Issue 4 - p 913–920
doi: 10.1097/TA.0000000000000169
AAST Plenary Papers
Editor's Choice

BACKGROUND Epidemiologic trends in trauma-related mortality in the United States require updating and characterization. We hypothesized that during the past decade, there have been changing trends in mortality that are associated with multiple public health and health care–related factors.

METHODS Multiple sources were queried for the period of 2002 to 2010: the National Trauma Data Bank, the National Centers for Disease Control, the National Highway Traffic Safety Administration, the Nationwide Emergency Department Sample, and the US Census Bureau. The incidence of injury and mortality for motor vehicle traffic (MVT) collisions, firearms, and falls were determined using National Centers for Disease Control data. National Highway Traffic Safety Administration data were used to determine motor vehicle collision information. Injury severity data were derived from the Nationwide Emergency Department Sample and National Trauma Data Bank. Analysis of mortality trends by year was performed using the Cochran-Armitage test for trend. Time-trend multivariable Poisson regression was used to determine risk-adjusted mortality over time.

RESULTS From 2002 to 2010, the total trauma-related mortality decreased by 6% (p < 0.01). However, mortality trends differed by mechanism. There was a 27% decrease in the MVT death rate associated with a 20% decrease in motor vehicle collisions, 19% decrease in the number of occupant injuries per collision, lower injury severity, and improved outcomes at trauma centers. While firearm-related mortality remained relatively unchanged, mortality caused by firearm suicides increased, whereas homicide-associated mortality decreased (p < 0.001 for both). In contrast, fall-related mortality increased by 46% (5.95–8.70, p < 0.01).

CONCLUSION MVT mortality rates have decreased during the last decade, owing in part to decreases in the number and severity of injuries. Conversely, fall-related mortality is increasing and is projected to exceed both MVT and firearm mortality rates should current trends continue. Trauma systems and injury prevention programs will need to take into account these changing trends to best accommodate the needs of the injured population.

LEVEL OF EVIDENCE Epidemiologic study, level III.

Supplemental digital content is available in the text.

From the Medical School (R.G.S.), University of California, San Francisco; and Trauma Service (R.Y.C.), Scripps Mercy Hospital, San Diego; and Department of Surgery (D.A.S., T.G.W., K.L.S.), Stanford University, Stanford, California.

Submitted: September 22, 2013, Revised: December 10, 2013, Accepted: December 17, 2013.

This study was presented at the 72nd annual meeting of the American Association for the Surgery of Trauma, September 18–21, 2013, in San Francisco, California.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Address for reprints: Kristan Staudenmayer, MD, MS, Department of Surgery, Stanford University, 300 Pasteur Dr, Grant Bldg, S-067, Stanford, CA 94305; email:

© 2014 Lippincott Williams & Wilkins, Inc.