Analysis of Preventable Trauma Deaths and Opportunities for Trauma Care Improvement in Utah

Sanddal, Teri L.; Esposito, Thomas J.; Whitney, Jolene R.; Hartford, Diane; Taillac, Peter; Mann, N. Clay; Sanddal, Nels D.

doi:10.1097/ta.0b013e3181fec9ba

Cited by 82 publications

(72 citation statements)

References 11 publications

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“…Certainly preventable deaths in Limb's study in England were reported to be 1-2%, in Sandall's study in the USA this was 0.7%, and in Falconer's study in New Zealand this was 10%. Thus, the rate in our study was the highest (8,17,18). Hussain and Redmond (9) declared the total rate of pre-hospital preventable deaths in England to be 39%, Mac Leod to be 7%, Mark Gunst to be 24%, Wilson in Brazil to be 1%, Meel to be 12% and Flaconer's in Newsland to be 45% (7,10,12,13,17).…”

Section: Discussionmentioning

confidence: 89%

Assessment of Causes of Preventable Deaths in Pre-hospital SettingsAssessment of Causes of Preventable Deaths in Pre-hospital Settings

Gholipour¹,

Rad²,

Vahdati³

et al. 2016

Erciyes Med J

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Objective: Death from trauma is a major problem for the health system. The determination of preventable deaths is a valuable indicator of quality and efficiency in the management of trauma patients. The purpose of our study was to investigate the cause of preventable death in pre-hospital settings in the city of Tabriz. Materials and Methods:In a cross-sectional study from 2013 to 2014 in Tabriz, all traumatic patients who died at the scene of trauma or during transport and before reaching the hospital were referred to forensics for autopsy studies. For all deaths, data on demographics, mechanism and type of injury, place of death, mode of transportation, injury to the central nervous system (CNS) and results of necropsy were recorded. Preventability of death was defined upon examination of the necropsy report.Results: In this study, 160 pre-hospital deaths were studied. The commonest mechanism of injury was a vehicular traffic accident (83.8%), and blunt trauma in 98.8% was the commonest type of injury. In total, 80.6% of the deaths were at the scene of trauma and 18.8% on arrival to the hospital. CNS injury was recorded in 71.9% of the cases. The commonest cause of death from the necropsy report was CNS injury (60.6%), exsanguination or breathing problems (28.1%), and CNS injury with exsanguination or breathing problems (11.2%). In this study, death was possibly preventable in 25.6% of the cases, and 21.9% of the deaths were definitively preventable. Conclusion:Many deaths occurred at the scene of trauma, and traffic accidents are the main mechanism of injury. A high percentage of deaths as seen in the autopsy had CNS injuries, and this was the main cause of death. The high rate of preventable death in the present study compared to that in similar studies in other countries is a significant finding.

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Section: Discussionmentioning

confidence: 89%

Assessment of Causes of Preventable Deaths in Pre-hospital SettingsAssessment of Causes of Preventable Deaths in Pre-hospital Settings

Gholipour¹,

Rad²,

Vahdati³

et al. 2016

Erciyes Med J

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“…The study was not designed to demonstrate whether any deaths could have been prevented by faster access to EMS. However, the proportion of deaths judged to have been preventable has varied from 7 to 15% in different studies, indicating how early recognition of severely injured patients, and appropriate therapeutic interventions are important components in pre‐hospital trauma care 32, 33…”

Section: Discussionmentioning

confidence: 99%

Fatal injuries in rural and urban areas in northern Finland: a 5‐year retrospective study

Raatiniemi

Steinvik

Liisanantti

et al. 2016

Acta Anaesthesiol Scand

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BackgroundFinland has the fourth highest injury mortality rate in the European Union. To better understand the causes of the high injury rate, and prevent these fatal injuries, studies are needed. Therefore, we set out to complete an analysis of the epidemiology of fatal trauma, and any contributory role for alcohol, long suspected to promote fatal injuries. As a study area, we chose the four northernmost counties of Finland; their mix of remote rural areas and urban centres allowed us to correlate mortality rates with ‘rurality’.MethodsThe Causes of Death Register was consulted to identify deaths from external causes over a 5‐year time period. Data were retrieved from death certificates, autopsy reports and medical records. The municipalities studied were classified as either rural or urban.ResultsOf 2915 deaths categorized as occurring from external causes during our study period, 1959 were eligible for inclusion in our study. The annual crude mortality rate was 54 per 100,000 inhabitants; this rate was higher in rural vs. urban municipalities (65 vs. 45 per 100,000 inhabitants/year). Additionally, a greater number of pre‐hospital deaths from accidental high‐energy trauma occurred in rural areas (78 vs. 69%). 42% of all pre‐hospital deaths occurred under the influence of alcohol.ConclusionThe crude mortality rate for fatal injuries was high overall as compared to other studies, and elevated in rural areas, where pre‐hospital deaths were more common. Almost half of pre‐hospital deaths occurred under the influence of alcohol.

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“…Chiara et al [4] suggested professional panel study, TRISS, and ICISS as a method of assessing preventable mortality rate. Professional panel study is a method widely used with long history [5,11]. However, during the initial working phase, it has a disadvantage of being subjective, which makes it not suitable for deciding the quality improvement in a single trauma center.…”

Section: Discussionmentioning

confidence: 99%

“…For this assessment, trauma and injury severity score (TRISS), International Classification of Disease-9 based injury severity score (ICISS), and professional panel study are widely used methods [4,5].…”

Section: Introductionmentioning

confidence: 99%

PARK Index and S-score Can Be Good Quality Indicators for the Preventable Mortality in a Single Trauma Center

Park

Lee

et al. 2017

Journal of Trauma and Injury

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Purpose: Preventable Trauma Death Rate (PTDR) using Trauma and Injury Severity Score (TRISS) has been most widely used as a quality indicator in South Korea. However, this method has a small number of deaths corresponding to the denominator. Therefore, it is difficult to check the change of quality improvement for annual mortality, and there is a disadvantage that variation is severe. Therefore, we attempted to improve the quality of the mortality evaluation by reducing the variation by applying the PARK Index (preventable major trauma death rate, PMTDR) which can increase the number of denominator significantly. And the Save score (S-score) was also examined as another quality indicator. Methods: In the PARK Index, the denominator is number of all patients who have survival probability (Ps) larger than 0.25. Numerator is the number of deaths among these. The PARK Index includes only patients with ISS >15. The S-score is calculated in the same way as the W-score, but the S-score includes only patients with ISS >15, which is a difference from the W-score. Results: PARK Index decreased annually and was 12.9 (37/287) in 2014, 9.6 (33/343) in 2015, and 7.3 (52/709) in 2016. S-score increased annually and was -0.29 in 2014, 4.21 in 2015, and 8.75 in 2016. Conclusions: PARK Index and S-score improved annually. This shows that both quality indicators are improving year by year. PARK Index (PMTDR) has 9.5-fold increase in denominator overall compared to PTDR by TRISS. The S-score used only ISS >15 patients as a denominator. Therefore, there is an advantage that the numerical value change is larger than the W-score. In addition, S-score is not affected by the ratio of major trauma patients to minor trauma patients.

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Analysis of Preventable Trauma Deaths and Opportunities for Trauma Care Improvement in Utah

Cited by 82 publications

References 11 publications

Assessment of Causes of Preventable Deaths in Pre-hospital SettingsAssessment of Causes of Preventable Deaths in Pre-hospital Settings

Assessment of Causes of Preventable Deaths in Pre-hospital SettingsAssessment of Causes of Preventable Deaths in Pre-hospital Settings

Fatal injuries in rural and urban areas in northern Finland: a 5‐year retrospective study

PARK Index and S-score Can Be Good Quality Indicators for the Preventable Mortality in a Single Trauma Center

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