Thoracic vascular injury remains the leading cause of death in traumatic haemorrhage: Analysis of injury patterns and time to death

PURPOSE: Understanding injury patterns and temporal dynamics of traumatic haemorrhagic death is essential for developing targeted interventions. This study characterized anatomic bleeding locations, specific vascular injuries, and survival times in patients who died from traumatic haemorrhage. METHODS: Retrospective single centre study of trauma patients who died in hospital from traumatic haemorrhage during index admission between 2007 and 2023. Data were extracted from systematic mortality reviews, trauma registries, medical records, and autopsy reports. Survival times were analyzed in relation to bleeding location and specific vascular injuries. RESULTS: In the overall cohort (n = 226), the median age was 33 years (IQR 23-51); male patients 85% (191/226). Penetrating trauma (58%, 130/226) dominated over blunt trauma (42%, 96/226) (p = 0.013). Thorax (n = 94, 42%) was the most common region for haemorrhage death followed by multiple locations (n = 89, 39%), abdomen (n = 33, 15%), extremities (n = 6, 2.7%), and neck (n = 4, 1.8%). Time-to-death categorization revealed that most deaths (40%) occurred between 60 and 120 min after injury, with 21% dying within the first 60 min. Thoracic fatal haemorrhage caused the shortest survival times (median 77 min, IQR 55-197), while abdominal haemorrhage had the longest survival time (127 min, IQR 93-251). The survival probability after 90 min for abdominal bleeding region was OR 3.89, 95% CI 1.27-11.9, p = 0.018. Thoracic aorta was the most frequent (42%, 47/113) identified vascular injury with the shortest survival (75 min, IQR 55-189). CONCLUSIONS: Thoracic haemorrhage, particularly when involving major vessels, represented the most lethal bleeding source with the shortest survival duration; in contrast, abdominal haemorrhage was associated with a comparatively longer survival window. These findings emphasize the critical importance of minimizing time to definitive haemorrhage control through expeditious surgical management strategies.