Int J Emerg Med (2010) 3:91–95 DOI 10.1007/s12245-009-0154-3 ORIGINAL RESEARCH ARTICLE Mortality in patients with loss of consciousness at the scene of trauma André Luciano Baitello & Francisco de Assis Cury & Paulo César Espada & Rogério Yukio Morioka & José Maria Pereira de Godoy Received: 19 July 2009 / Accepted: 8 December 2009 / Published online: 9 February 2010 # Springer-Verlag London Ltd 2010 Abstract Background and aim: The aim of this study was to evaluate if loss of consciousness at the scene of an accident in patients with thoracic trauma classified by the Abbreviated Injury Scale (AIS) as thorax >2 has a different outcome in respect to immediate hospital discharge, hospitalization, death and type of accident. Methods: A prospective study was performed in the Regional Trauma Center of São José do Rio Preto. All patients with scores related to thoracic injury ≥2 were included in this study. Thus, 134 patients with penetrating and 231 with blunt thoracic injuries were evaluated. The chi-square, Fisher's exact and relative risk tests were utilized for statistical analysis with an alpha error greater than 5% (p < 0.05) being considered statistically significant. Results: A significantly higher number of patients who lost consciousness (35–33.9%) died compared to those who did not lose consciousness (9–3.5%, Fisher's exact test: p< 0.0001) where the relative risk (RR) of death when an individual lost consciousness was 9.7 (95% CI: 4.8–19.4). In respect to the necessity of hospital treatment, those who lost consciousness were more commonly hospitalized (Fisher's exact test: p < 0.0001). A. L. Baitello : F. de Assis Cury : P. C. Espada : R. Y. Morioka Department of Trauma, Medical School of São José do Rio Preto, FAMERP, São Paulo, Brazil J. M. P. de Godoy (*) Cardiology and Cardiovascular Surgery Department, Medical School of São José do Rio Preto-FAMERP, Rua Floriano Peixoto, 2950, São José do Rio Preto, SP 15020-010, Brazil e-mail: godoyjmp@riopreto.com.br Conclusion: The loss of consciousness at the time of trauma is a warning sign in patients with thoracic injuries whether associated with other types of injuries or not. Keywords Loss of consciousness . Thoracic trauma . Mortality Introduction The incidence of thoracic injuries in the USA is 12 per 1 million inhabitants per day, with 20 to 25% of the deaths resulting from trauma attributed to thoracic injuries. It is estimated that thoracic injuries account for approximately 16,000 deaths in the USA annually [1–4]. The lungs, rib, stern, scapula, diaphragm, heart and aorta are the most important regions of injury in thorax trauma [5–7]. Chest x-ray is the initial primary imaging examination for the evaluation of the thorax in polytrauma patients, enabling an assessment of the extent of injuries and early screening for management decisions [8]. The Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS), which are accurate methods to assess the severity of injuries and have many potential applica- tions, have been introduced in emergency medicine [9]. The AIS is a consensus-derived, anatomically based system of grading injuries on a non-linear scale ranging from 1 (minor injury) to 6 (lethal injury) [10, 11]. Loss of memory is most commonly reported with brain trauma [12, 13]; however, the association between loss of memory at the time of the initial treatment and the evolution of these patients has not been stressed in the