Effect of a Voluntary Trauma System on Preventable Death and Inappropriate Care in a Rural State

Esposito, Thomas J.; Sanddal, Teri L.; Reynolds, Stuart; Sanddal, Nels D.

doi:10.1097/01.ta.0000058124.78958.6b

Cited by 98 publications

(69 citation statements)

References 12 publications

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“…Some of the most common errors reported during this phase of the treatment are related to the failure in the accomplishment of these principles [7,9,10].…”

Section: Evaluation and Treatment Of The Circulatory Statementioning

confidence: 99%

“…These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant.…”

mentioning

confidence: 99%

“…Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant.…”

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confidence: 99%

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Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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“…Some of the most common errors reported during this phase of the treatment are related to the failure in the accomplishment of these principles [7,9,10].…”

Section: Evaluation and Treatment Of The Circulatory Statementioning

confidence: 99%

mentioning

confidence: 99%

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Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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“…Travma merkezlerine müracaat eden hastalarda ilk 24 saat içindeki ölümle-rin en sık nedeni kanama ve koagülopati olup, ölüm-lerin yaklaşık %50'sinin nedenini oluşturmaktadır (1) . Travma nedeniyle sağlık merkezlerine kabul edilen hastaların büyük çoğunluğunu genç ve sağlıklı yaş grubu oluşturduğundan bugün için referans merkezlerde kanama nedeniyle hasta kaybedilmemelidir.…”

Section: Introductionunclassified

Blood Transfusion and Massive Transfusion Protocols in War and Terror

Kılbaş¹,

Kaymak²

2017

Okmeydani Medical Journal

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“…2 In addition, preventable mortality in trauma patients is 35.2%, which is very high compared to the United States or Japan, whose preventable mortality rates in trauma patients range from 10% to 15%. 3,4 Because death caused by injury occurs mostly when one is of a working age, there are costs associated with such social losses. 5 In South Korea, emergency medical institutions are divided into three types: regional emergency medical centres, local emergency medical centres, and local emergency medical institutions; these are categorized based on the facilities, personnel, and equipment for each region (see Supplementary Material).…”

Section: Introductionmentioning

confidence: 99%

Positive correlation between regional emergency medical resources and mortality in severely injured patients: results from the Korean National Hospital Discharge In-depth Survey

Lee

Park

2016

CJEM

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Objectives: In South Korea, injury is a public health problem due to its high incidence and high mortality. To improve emergency medical systems, the government announced plans to increase the emergency medical resources for each region. This study investigated the association between regional emergency medical resources and mortality during hospitalization in severely injured inpatients. Methods: To analyse mortality for severely injured inpatients, we used the Korean National Hospital Discharge In-depth Survey data, consisting of 18,621 hospitalizations from [2005][2006][2007][2008][2009][2010][2011][2012]. Generalized estimating equations were analysed to examine the association between mortality during hospitalization and both individual and regional variables. Conclusions: Our findings suggest that regional emergency medical resources are associated with a lower risk of mortality during hospitalization in severely injured patients. Thus, health care policymakers need to determine the proper distribution of emergency medical resources for each region and the function of emergency departments to provide a superior quality of emergency medical services to patients. Conclusions : D'après les constatations de l'étude, la disponibilité des ressources médicales d'urgence en région est associée à une diminution du risque de mortalité en cours d'hospitalisation chez les blessés graves. Aussi les décideurs de politiques en matière de soins de santé doivent-ils déterminer une distribution appropriée des ressources médicales d'urgence dans chaque région et tenir compte de la fonction des SU afin d'offrir aux patients des services médicaux d'urgence de qualité.

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Effect of a Voluntary Trauma System on Preventable Death and Inappropriate Care in a Rural State

Abstract: Implementation of a voluntary trauma system has positive effects on PDR and inappropriate care. The degree and nature of inappropriate care remain a concern. Mandated and funded system policies may further influence care positively.

Cited by 98 publications

References 12 publications

Critical Care Issues in the Early Management of Severe Trauma

Critical Care Issues in the Early Management of Severe Trauma

Blood Transfusion and Massive Transfusion Protocols in War and Terror

Positive correlation between regional emergency medical resources and mortality in severely injured patients: results from the Korean National Hospital Discharge In-depth Survey

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