Identification of Preventable Trauma Deaths

Wilson, David; McElligott, J.; Fielding, L P

doi:10.1097/00005373-199201000-00010

Cited by 85 publications

(21 citation statements)

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“…However, patients with severe head injury (AIS more than 5) were mainly located at this point. This is because patients with brain injuries are at a greater risk of death than other injured people [11], and some researchers have suggested that such deaths be excluded from the analysis of trauma outcome including preventable death [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Trauma Outcome between Urban and Suburban Hospital

Choi¹,

Lee

Hong³

et al. 2006

Eur J Trauma

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This study compared the trauma outcome between urban and suburban hospitals. The medical records of patients admitted to the intensive care unit (ICU) following trauma, obtained from 1994 to 1995 and 2002 to 2003, were examined. One was a tertiary university teaching hospital with regional emergency medical center (EMC), and the other was a small general hospital in a suburban area. Since 1999, the suburban hospital has enlarged its capacities to include EMC. In this study, the standardizing W (Ws), 95% confidence interval (CI) of Ws, and the predicted survival rate (Ps) were calculated using the Trauma and Injury Severity Score (TRISS) method. From 1994 to 1995, 225 and 121 records of the urban and suburban hospital were reviewed, respectively. The performance of trauma care in the urban hospital was more accurate than that in the suburban (95% CI of the Ws in urban and small suburban hospital: -2.30 to 2.73 and -11.40 to -5.90, respectively). The actual survival rate of the suburban hospital was significantly lower than the predicted survival rate at all revised trauma score (RTS). From 2002 to 2003, 315 and 268 medical records of urban and suburban hospital were reviewed, respectively. The 95% CI of the Ws in urban and suburban hospital was -3.56 to 0.24 and -3.73 to 0.26, respectively. In addition, there were no differences in the distribution of actual survival rate that was compared with the predicted survival rate according to injury severity score (ISS) and RTS in each hospital. After increasing the capacity of the suburban hospital, the trauma care performance was more accurate, and the ability of the physiologic support had improved. In addition, a larger suburban hospital could manage more severely injured patients without the need for transfer (mean ISS from 1994(mean ISS from -1995(mean ISS from to 2002(mean ISS from -2003.0 vs. 24.3, p = 0.059, mean RTS: 7.0 and 6.2, p = 0.003; transfer:admission ratio = 0.182:0.056, respectively, p = 0.01). In conclusion, under the wellconstructed emergency medical service system, the enlargement of the capacities of emergency and intensive care should improve the performance of trauma care in suburban hospital.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Trauma Outcome between Urban and Suburban Hospital

Choi¹,

Lee

Hong³

et al. 2006

Eur J Trauma

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“…On the other hand, the problem of defining a preventable remains controversial [13,21]. In a comparative study MacKenzie et al [21] asked different expert groups to assess a cohort of 130 trauma deaths.…”

Section: Discussionmentioning

confidence: 99%

“…Expectations regarding the results of treatment have been growing continuously. Numerous analyses published during the past three decades have identified the possible complications in the treatment of severely injured patients leading to preventable deaths [1,2,3,4,5,6,7,8,9,10,11,12,13]. The following measures have been proposed for resolving these problems: tool for improving treatment and reducing the rate of preventable deaths (from 42-28% to 14-2%) [2,5,6,10].…”

Section: Introductionmentioning

confidence: 99%

A multidisciplinary quality management system for the early treatment of severely injured patients: implementation and results in two trauma centers

Ruchholtz

Waydhas

Lewan

et al. 2002

Intensive Care Medicine

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“…Detailed analysis of these "unexpected fatalities", however, identified only 11% as possibly preventable deaths. The assessment of preventability of death by audit meetings has, however, also been found to be highly subjective [23,24]. Recent articles attempted to use the methodologies on an individual level, stating improvements in sensitivity and specificity by using a number of additional variables needed to predict outcome.…”

Section: Discussionmentioning

confidence: 99%

Predicting Survival after Trauma: a Comparison of TRISS and ASCOT in the Netherlands

Frankema

Edwards

Steyerberg

et al. 2002

European Journal of Trauma

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Background: Evaluating the performance of a trauma system may be attempted by comparing outcome in different trauma populations. Controlling for injury severity is a necessity for such evaluations. We compare two current models for doing so: the "Trauma and Injury Severity Score" (TRISS) and "A Severity Characterization Of Trauma" (ASCOT). Material and Methods:This study of high-energy trauma victims took place in Leiden, the Netherlands, between 1993 and 1998. Using the Hosmer-Lemeshow (HL) test and receiver operator characteristic (ROC) analysis, the TRISS and ASCOT models were compared for calibration and discrimination. Results: 1,024 patients, with an average Injury Severity Score (ISS) of 13.5, were eligible for inclusion. Blunt trauma was the predominant cause of injuries. Both models gave accurate, though pessimistic, results in predicting the actual number of fatalities (n = 71). The HL test indicated a sufficient fit for the ASCOT model (p = 0.28) and an insufficient fit (p = 0.02) for TRISS. The ROC curves were nearly identical (0.97). Including age as a linear variable, instead of using the current age groups, resulted in an improved discriminative power of the models. Conclusions: The ASCOT model proved superior over TRISS in its accuracy to estimate of survival chances. This difference was most evident for victims with an estimated survival chance of 60-90%. Future national trauma researchers should therefore collect ASCOT data. Improved ASCOT models could be developed, with age as a linear variable.

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Identification of Preventable Trauma Deaths

Cited by 85 publications

References 0 publications

Comparison of the Trauma Outcome between Urban and Suburban Hospital

Comparison of the Trauma Outcome between Urban and Suburban Hospital

A multidisciplinary quality management system for the early treatment of severely injured patients: implementation and results in two trauma centers

Predicting Survival after Trauma: a Comparison of TRISS and ASCOT in the Netherlands

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