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Initial management of trauma in adults

Ali Raja, MD, MBA, MPH
Richard D Zane, MD
Section Editor
Maria E Moreira, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Traumatic injuries can range from minor isolated wounds to complex injuries involving multiple organ systems. All trauma patients require a systematic approach to management in order to maximize outcomes and reduce the risk of undiscovered injuries.

This review will discuss the initial management of adult trauma patients. The management of pediatric trauma patients and specific injuries are reviewed separately. (See "Trauma management: Approach to the unstable child" and "Trauma management: Unique pediatric considerations" and "Initial evaluation and management of shock in adult trauma".)


Trauma is a leading cause of mortality globally [1]. Worldwide, road traffic injuries are the leading cause of death between the ages of 18 and 29, while in the United States, trauma is the leading cause of death in young adults and accounts for 10 percent of all deaths among men and women [2]. Over 45 million people sustain moderate to severe disability each year due to trauma [1]. In the United States alone, more than 50 million patients receive some form of trauma-related medical care for annually, and trauma accounts for approximately 30 percent of all intensive care unit (ICU) admissions [3,4].

According to the World Health Organization (WHO), road traffic injuries accounted for 1.25 million deaths w in 2014, and trauma is expected to rise to the third leading cause of disability worldwide by 2030 [1,5]. Outside areas of armed conflict, penetrating injuries are responsible for fewer than 15 percent of traumatic deaths worldwide [6], but these rates vary by country. As examples, while homicide accounts for as many as 45 percent of deaths in Los Angeles, penetrating injuries account for only 13 percent of deaths in Norway [7]. Approximately half of traumatic deaths result from central nervous system (CNS) injury, while a third from exsanguination [8].

Patients with serious traumatic injuries have a significantly lower likelihood of mortality or morbidity (10.4 versus 13.8 percent; relative risk [RR] 0.75, 95% CI 0.60-0.95) when treated at a designated trauma center [9]. Older age, obesity, and major comorbidities are associated with worse outcomes following trauma [10-18]. In trauma patients with significant hemorrhage, a lower score on the Glasgow Coma Scale (GCS) and older age are both independently associated with increased mortality, according to multivariable logistic regression analysis of two large databases [19]. In a large retrospective study from the United States National Trauma Data Bank, warfarin use was associated with an approximately 70 percent increased risk of mortality following trauma, after adjusting for other important risk factors (odds ratio [OR] 1.72; 95% CI 1.63-1.81) [20].


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