to improved prehospital care or specialized treatment centers. of those who reach the hospital alive but then die, most do so within the first two hours of arrival. the sooner a tbi is diagnosed, the higher the mortality rate; this is likely due to other accompanying injuries that prove fatal. accompanying injuries often play a key role in the outcome. injuries that may accompany tbi include pulmonary contusion and laceration; and fractures of the sternum, ribs and clavicles. spinal cord injury, facial trauma, traumatic aortic rupture, injuries to the abdomen, lung, and head are present in 40–100%. the most common accompanying injury is esophageal perforation or rupture (known as boerhaave syndrome), which occurs in as many as 43% of the penetrating injuries to the neck that cause tracheal injury. history throughout most of history, the mortality rate of tbi was thought to be 100%. however, in 1871 a healed tbi was noted in a duck that had been killed by a hunter, thus demonstrating that the injury could be survived, at least in the general sense. this report, made by winslow, was the first record in the medical literature of a bronchus injury. in 1873, seuvre made one of the earliest reports of tbi in the medical literature: a 74-year-old woman whose chest was crushed by a wagon wheel was found on autopsy to have an avulsion of the right bronchus. long-term survival of the injury was unknown in humans until a report was made of a person who survived in 1927. in 1931, a report made by nissen described successful removal of a lung in a 12-year-old girl who had had narrowing of the bronchus due to the injury. repair of tbi was probably first attempted in 1945, when the first documented case of a successful suturing of a lacerated bronchus was made. prior to 1950, the mortality rate was 36%; it had fallen to 9% by 2001; this improvement was likely due to improvements in treatments and surgical techniques, including those for injuries commonly associated with tbi. notes le guen m, beigelman c, bouhemad b, wenjïe y, marmion f, rouby jj (2007). 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