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Background  In the acute care of trauma, some patients with a low estimated risk of death die suddenly and unexpectedly. In this study, we aim to identify predictors for early death within 24 h following hospital admission in low-risk patients.    Methods  The TraumaRegister DGU® was used to collect records of patients who were primarily treated in a participating hospital between 2004 and 2013 with a RISC II score below 10%.    Results  During the study period, 64,379 patients met the inclusion criteria. The mean RISC II score was 2.0%, and the mean ISS was 16 ± 9. The overall hospital mortality rate was 2.1%, and 0.5% of patients ( n  = 301) died within the first 24 h. A SPB of ≤ 90 mmHg was associated with an increased risk of death ( p  < 0.001). An AIS abdomen score of ≥ 3 was associated with increased risk of death within the first 24 h ( p  < 0.001). A high risk of early death was also seen in patients with an AIS score (thorax) ≥ 3; 51% of those who died died within the first 24 h ( p  < 0.005). Death in patients over 60 years was more common after 24 h ( p  < 0.001). Patients with an ASA score of ≥ 3 were more likely to die after the first 24 h ( p  < 0.001).    Conclusions  Indicators predicting a high risk of early death in patients with a low RISC II score include a SPB ≤ 90 mmHg and severe chest and abdominal trauma. Emergency teams involved in the acute care of trauma patients should be aware of these “red flags” and treat their patients accordingly.

world journal of emergency surgery

Training to identify red flags in the acute care of trauma: who are the patients at risk for early death despite a relatively good prognosis? An analysis from the TraumaRegister DGU®