BACKGROUND: Analysis of the epidemiology and attribution of in-hospital deaths is a critical component of learning and process improvement for any trauma center. We sought to perform a detailed analysis of in-hospital deaths at a combat support hospital. METHODS: All patients with trauma who survived to admission and subsequently died before transfer or discharge during a 1-year period were included. The timing, location, pathogenesis, and circumstances surrounding the death were recorded. Opportunities for improvement (OI) of care were identified for analysis. Cases were presented to a panel of experts, and preventability of the deaths was scored on a continuous 10-point scale. RESULTS: There were 151 deaths, with the predominant mechanisms of gunshot wounds (GSW) (47%) and blast injuries (42%). Most had severe injuries, with a mean Injury Severity Score of 38, pH of 7.09, and base deficit of 12. Predominant causes of death were head injury (45%) and hemorrhage (32%), and 78% died within 1 hour of admission. Most deaths occurred during the intensive care (35%) or resuscitation phases (31%), but the majority of deaths among nonexpectant patients occurred during the operative phase (38%). OI were identified in 74 deaths (49%), and were found in 78% of nonexpectant deaths. Most improvement opportunities occurred during the resuscitation and transport phases. Most potential improvements were identified at the system level (54%) or individual provider level (42%). Preventability scoring showed excellent inter-rater reliability (r = 0.92, p < 0.001). Deaths with high preventability scores (mean >54) were primarily related to delays in hemorrhage control during the transportation (47%) or resuscitation (43%) phases, and attributed to the system (63%) and individual provider levels (70%). CONCLUSIONS: In-hospital combat trauma-related deaths at a modern Combat support hospital differ significantly from their civilian counterparts, and present multiple OI of care and potential salvage. Delays in prehospital and in-hospital hemorrhage control are the primary contributors to potential preventability.
BACKGROUND: Analysis of the epidemiology and attribution of in-hospital deaths is a critical component of learning and process improvement for any trauma center. We sought to perform a detailed analysis of in-hospital deaths at a combat support hospital. METHODS: All patients with trauma who survived to admission and subsequently died before transfer or discharge during a 1-year period were included. The timing, location, pathogenesis, and circumstances surrounding the death were recorded. Opportunities for improvement (OI) of care were identified for analysis. Cases were presented to a panel of experts, and preventability of the deaths was scored on a continuous 10-point scale. RESULTS: There were 151 deaths, with the predominant mechanisms of gunshot wounds (GSW) (47%) and blast injuries (42%). Most had severe injuries, with a mean Injury Severity Score of 38, pH of 7.09, and base deficit of 12. Predominant causes of death were head injury (45%) and hemorrhage (32%), and 78% died within 1 hour of admission. Most deaths occurred during the intensive care (35%) or resuscitation phases (31%), but the majority of deaths among nonexpectant patients occurred during the operative phase (38%). OI were identified in 74 deaths (49%), and were found in 78% of nonexpectant deaths. Most improvement opportunities occurred during the resuscitation and transport phases. Most potential improvements were identified at the system level (54%) or individual provider level (42%). Preventability scoring showed excellent inter-rater reliability (r = 0.92, p < 0.001). Deaths with high preventability scores (mean >54) were primarily related to delays in hemorrhage control during the transportation (47%) or resuscitation (43%) phases, and attributed to the system (63%) and individual provider levels (70%). CONCLUSIONS: In-hospital combat trauma-related deaths at a modern Combat support hospital differ significantly from their civilian counterparts, and present multiple OI of care and potential salvage. Delays in prehospital and in-hospital hemorrhage control are the primary contributors to potential preventability.
Authors: George Edward Black; Kyle K Sokol; Donald M Moe; Jon D Simmons; David Muscat; Victor Pastukh; Gina Capley; Olena Gorodnya; Mykhaylo Ruchko; Mark B Roth; Mark Gillespie; Matthew J Martin Journal: J Trauma Acute Care Surg Date: 2017-10 Impact factor: 3.313
Authors: Rolf Rossaint; Bertil Bouillon; Vladimir Cerny; Timothy J Coats; Jacques Duranteau; Enrique Fernández-Mondéjar; Beverley J Hunt; Radko Komadina; Giuseppe Nardi; Edmund Neugebauer; Yves Ozier; Louis Riddez; Arthur Schultz; Philip F Stahel; Jean-Louis Vincent; Donat R Spahn Journal: Crit Care Date: 2010-04-06 Impact factor: 9.097
Authors: Aaron M Williams; Umar F Bhatti; Isabel S Dennahy; Nathan J Graham; Vahagn C Nikolian; Kiril Chtraklin; Panpan Chang; Jing Zhou; Ben E Biesterveld; Jonathan Eliason; Hasan B Alam Journal: J Trauma Acute Care Surg Date: 2019-03 Impact factor: 3.313
Authors: Leopoldo C Cancio; Andriy I Batchinsky; William L Baker; Corina Necsoiu; José Salinas; Ary L Goldberger; Madalena D Costa Journal: J Crit Care Date: 2013-10-17 Impact factor: 3.425
Authors: Rolf Rossaint; Bertil Bouillon; Vladimir Cerny; Timothy J Coats; Jacques Duranteau; Enrique Fernández-Mondéjar; Daniela Filipescu; Beverley J Hunt; Radko Komadina; Giuseppe Nardi; Edmund A M Neugebauer; Yves Ozier; Louis Riddez; Arthur Schultz; Jean-Louis Vincent; Donat R Spahn Journal: Crit Care Date: 2016-04-12 Impact factor: 9.097