BACKGROUND: The objective is to determine the rate of preventable mortality and the volume and nature of opportunities for improvement (OFI) in care for cases of traumatic death occurring in the state of Utah. METHODS: A retrospective case review of deaths attributed to mechanical trauma throughout the state occurring between January 1, 2005, and December 31, 2005, was conducted. Cases were reviewed by a multidisciplinary panel of physicians and nonphysicians representing the prehospital and hospital phases of care. Deaths were judged frankly preventable, possibly preventable, or nonpreventable. The care rendered in both preventable and nonpreventable cases was evaluated for OFI according to nationally accepted guidelines. RESULTS: The overall preventable death rate (frankly and possibly preventable) was 7%. Among those patients surviving to be treated at a hospital, the preventable death rate was 11%. OFIs in care were identified in 76% of all cases; this cumulative proportion includes 51% of prehospital contacts, 67% of those treated in the emergency department (ED), and 40% of those treated post-ED (operating room, intensive care unit, and floor). Issues with care were predominantly related to management of the airway, fluid resuscitation, and chest injury diagnosis and management. CONCLUSIONS: The preventable death rate from trauma demonstrated in Utah is similar to that found in other settings where the trauma system is under development but has not reached full maturity. OFIs predominantly exist in the ED and relate to airway management, fluid resuscitation, and chest injury management. Resource organization and education of ED primary care providers in basic principles of stabilization and initial treatment may be the most cost-effective method of reducing preventable deaths in this mixed urban and rural setting. Similar opportunities exist in the prehospital and post-ED phases of care.
BACKGROUND: The objective is to determine the rate of preventable mortality and the volume and nature of opportunities for improvement (OFI) in care for cases of traumatic death occurring in the state of Utah. METHODS: A retrospective case review of deaths attributed to mechanical trauma throughout the state occurring between January 1, 2005, and December 31, 2005, was conducted. Cases were reviewed by a multidisciplinary panel of physicians and nonphysicians representing the prehospital and hospital phases of care. Deaths were judged frankly preventable, possibly preventable, or nonpreventable. The care rendered in both preventable and nonpreventable cases was evaluated for OFI according to nationally accepted guidelines. RESULTS: The overall preventable death rate (frankly and possibly preventable) was 7%. Among those patients surviving to be treated at a hospital, the preventable death rate was 11%. OFIs in care were identified in 76% of all cases; this cumulative proportion includes 51% of prehospital contacts, 67% of those treated in the emergency department (ED), and 40% of those treated post-ED (operating room, intensive care unit, and floor). Issues with care were predominantly related to management of the airway, fluid resuscitation, and chest injury diagnosis and management. CONCLUSIONS: The preventable death rate from trauma demonstrated in Utah is similar to that found in other settings where the trauma system is under development but has not reached full maturity. OFIs predominantly exist in the ED and relate to airway management, fluid resuscitation, and chest injury management. Resource organization and education of ED primary care providers in basic principles of stabilization and initial treatment may be the most cost-effective method of reducing preventable deaths in this mixed urban and rural setting. Similar opportunities exist in the prehospital and post-ED phases of care.
Authors: Joseph Utecht; John Judkins; J Neil Otte; Terra Colvin; Nicholas Rogers; Robert Rose; Maria Alvi; Amanda Hicks; Jane Ball; Stephen M Bowman; Robert T Maxson; Rosemary Nabaweesi; Rohit Pradhan; Nels D Sanddal; M Eduard Tudoreanu; Robert J Winchell; Mathias Brochhausen Journal: CEUR Workshop Proc Date: 2016-08
Authors: V A Reva; Y Matsumura; T Hörer; D A Sveklov; A V Denisov; S Y Telickiy; A B Seleznev; E R Bozhedomova; J Matsumoto; I M Samokhvalov; J J Morrison Journal: Eur J Trauma Emerg Surg Date: 2016-10-13 Impact factor: 3.693
Authors: Dominic Yeboah; Charles Mock; Patrick Karikari; Peter Agyei-Baffour; Peter Donkor; Beth Ebel Journal: World J Surg Date: 2014-07 Impact factor: 3.352
Authors: Y Matsumura; J Matsumoto; K Idoguchi; H Kondo; T Ishida; Y Kon; K Tomita; K Ishida; T Hirose; K Umakoshi; T Funabiki Journal: Eur J Trauma Emerg Surg Date: 2017-08-22 Impact factor: 3.693
Authors: Roman Pfeifer; Sascha Halvachizadeh; Sylvia Schick; Kai Sprengel; Kai Oliver Jensen; Michel Teuben; Ladislav Mica; Valentin Neuhaus; Hans-Christoph Pape Journal: World J Surg Date: 2019-10 Impact factor: 3.352