Identifying preventable trauma death: does autopsy serve a role in the peer review process?

Scantling, Dane; Teichman, Amanda; Kucejko, Robert J.; McCracken, Brendan; Eakins, James; Burns, Richard A.

doi:10.1016/j.jss.2017.03.068

Cited by 5 publications

(2 citation statements)

References 18 publications

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“…The value of autopsy to the quality assurance of trauma‐related death is controversial [1, 5, 6, 18–22]. In the present study, ten marginal and one evident clinical discrepancies and four marginal forensic discrepancies occurred among seven cases.…”

Section: Discussionmentioning

confidence: 59%

Synergistic Effects of Forensic Medicine and Traumatology: Comparison of Clinical Diagnosis Autopsy Findings in Trauma‐Related Deaths

et al. 2020

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Background Trauma is the third leading cause of death worldwide after cardiovascular and oncologic diseases. Predominant causes of trauma-related death (TD) are severe traumatic brain injury (sTBI), hemorrhagic shock, and multiple organ failure. An analysis of TD is required in order to review the quality of trauma care and grasp how well the entire trauma network functions, especially for the most severely injured patients. Furthermore, autopsies not only reveal hidden injuries, but also verify clinical assumed causes of death. Material During the study period of 3 years, a total of 517 trauma patients were admitted to our supraregional University Centre of Orthopaedics and Traumatology in Dresden. 13.7% (71/517) of the patients died after trauma, and in 25 cases (35.2%), a forensic autopsy was instructed by the federal prosecutor. The medical records, death certificates, and autopsy reports were retrospectively evaluated and the clinical findings matched to autopsy results. Results The observed mortality rates (13.7%) were 4.2% less than expected by the calculated RISC II probability of survival (mortality rate of 17.9%). The most frequent trauma victims were due to falls >3 m (n = 29), followed by traffic accidents (n = 28). The median ISS was 34, IQR 25, and the median New ISS (NISS) was 50, IQR 32. Locations of death were in emergency department (23.9%), ICU (73.2%), OR and ward (1.4%, respectively). Clinicians classified 47.9% of deaths due to sTBI (n = 34), followed by 9.9% thoracic trauma and multiple organ failure (n = 7), 8.4% multiple trauma (n = 6), and 2.8% hypoxia and exsanguination (n = 2). In 18.3%, cases were unspecific or other causes of death recorded on the death certificates. Evident differences with evident clinical consequences were ascertained in 4% (n = 1) and marginal clinical consequences in 24% (6/25). In 16% (4/25), marginal differences with minor forensic consequences were revealed. Conclusions Even in a supraregional trauma center, specialized in multiple trauma management (4.2% survival benefit), room for improvement exists in more than a quarter of all casualties. This underlines the need for higher autopsy rates to uncover missed injuries and to understand the pathomechanism in each trauma fatality. This would also help to uncover potential insufficiencies in clinical routines with regard to diagnostics. The interdisciplinary cooperation of trauma surgeons and forensic pathologists can increase the quality of trauma patient care.

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Section: Discussionmentioning

confidence: 59%

Synergistic Effects of Forensic Medicine and Traumatology: Comparison of Clinical Diagnosis Autopsy Findings in Trauma‐Related Deaths

et al. 2020

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“…Measurement of error is an important step in identifying and reducing errors, and the autopsy is the historical starting point for identifying medical errors. [58][59][60] This power to detect large and small diagnostic error is known to persist in numerous studies, despite increasingly sophisticated diagnostic techniques including imaging. [61][62][63][64][65][66][67] Unfortunately, although the value of the autopsy in detecting diagnostic errors is welldocumented, the autopsy rate continues to fall in both academic and nonacademic hospitals.…”

Section: Reducing Diagnostic Errorsmentioning

confidence: 99%

The Value Proposition for Pathologists: A Population Health Approach

Ducatman

Crawford

et al. 2020

Academic Pathology

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The transition to a value-based payment system offers pathologists the opportunity to play an increased role in population health by improving outcomes and safety as well as reducing costs. Although laboratory testing itself accounts for a small portion of health-care spending, laboratory data have significant downstream effects in patient management as well as diagnosis. Pathologists currently are heavily engaged in precision medicine, use of laboratory and pathology test results (including autopsy data) to reduce diagnostic errors, and play leading roles in diagnostic management teams. Additionally, pathologists can use aggregate laboratory data to monitor the health of populations and improve health-care outcomes for both individual patients and populations. For the profession to thrive, pathologists will need to focus on extending their roles outside the laboratory beyond the traditional role in the analytic phase of testing. This should include leadership in ensuring correct ordering and interpretation of laboratory testing and leadership in population health programs. Pathologists in training will need to learn key concepts in informatics and data analytics, health-care economics, public health, implementation science, and health systems science. While these changes may reduce reimbursement for the traditional activities of pathologists, new opportunities arise for value creation and new compensation models. This report reviews these opportunities for pathologist leadership in utilization management, precision medicine, reducing diagnostic errors, and improving health-care outcomes.

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Spectral analysis of heart rate variability for trauma outcome prediction: an analysis of 210 ICU multiple trauma patients

Luo

Gao

et al. 2019

Eur J Trauma Emerg Surg

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Identifying preventable trauma death: does autopsy serve a role in the peer review process?

Cited by 5 publications

References 18 publications

Synergistic Effects of Forensic Medicine and Traumatology: Comparison of Clinical Diagnosis Autopsy Findings in Trauma‐Related Deaths

Synergistic Effects of Forensic Medicine and Traumatology: Comparison of Clinical Diagnosis Autopsy Findings in Trauma‐Related Deaths

The Value Proposition for Pathologists: A Population Health Approach

Spectral analysis of heart rate variability for trauma outcome prediction: an analysis of 210 ICU multiple trauma patients

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