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Injury. 2008 Sep;39(9):993-1000. doi: 10.1016/j.injury.2008.03.033. Epub 2008 Jul 25.

Applicability of the trimodal distribution of trauma deaths in a Level I trauma centre in the Netherlands with a population of mainly blunt trauma.

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  • 1University Medical Center Utrecht, Utrecht, The Netherlands. kikaknegt@gmail.com



Death due to trauma is assumed to follow a trimodal distribution. Since 1995 measures have been taken to regulate organisations involved in trauma care systems in the Netherlands. In estimating the effect of this system we have evaluated the time of death distribution in the University Medical Centre Utrecht (UMCU).


Prospectively collected databases of all trauma victims between January 1996 and December 2005 were retrospectively reviewed. All traumatic deaths were included. Cause of death was divided into exsanguination, thorax, CNS, organ failure, pneumonia, other and unknown.


Nine thousand eight hundred and five patients were admitted after trauma; of these patients 659 (6.7%) died. Blunt trauma occurred in 615/659 (93.3%) patients. The temporal distribution did not show a trimodal distribution. One predominant peak was observed, <or=1h after arrival at the emergency unit. Within the first day 310/659 (47%) deaths occurred, of which 76/310 (11.5%) <or=1h. CNS injuries were significantly the main cause of death; 334/659 (50.7%, p<0.05). Exsanguination was the main cause of death <or=1h; 31/76 (40.8%, p<0.05). Both CNS injuries and organ failure were the main causes of late death; >or=14 days, 28% and 29%, respectively.


No trimodal distribution was confirmed. Only one predominant peak, with a rapid decline, was observed within the first hour after trauma. Even analysed for different causes of death, the trimodal distribution could not be demonstrated. In particular death due to CNS injury showed a complete absence of any peaks.

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