Preventability of trauma deaths in a Dutch Level-1 trauma centre

Saltzherr, Teun Peter; Wendt, Klaus W.; Nieboer, Patrick; Nijsten, Maarten; Valk, Jens P; Luitse, Jan S. K.; Ponsen, Kees-Jan; Goslings, J. Carel

doi:10.1016/j.injury.2010.04.007

Cited by 41 publications

(33 citation statements)

References 17 publications

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“…Currently, EMS systems follow the same idea (4). Due to the necessity of correct diagnosis and treatment in stressful situations, the probability of medical mistakes or wrong management is high (5). For the first time in 1970, the idea of preventable deaths due to trauma was discussed by Rutstein et al (6).…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…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%

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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“…An external multidisciplinary review of deaths at a Dutch trauma center with a structured approach led to increased identification of quality of care issues, although no actions arising were described. 16 A multidisciplinary approach to M&M rounds at an American trauma center was described by Taylor and Tesfamariam 17 using a system-based analysis and distribution of minutes to hospital administration. There was no measurement of any specific educational or quality outcomes for this study.…”

Section: Discussionmentioning

confidence: 99%

Enhancing the Quality of Morbidity and Mortality Rounds: The Ottawa M&M Model

Calder

Kwok

Cwinn

et al. 2014

Academic Emergency Medicine

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Objectives: The objective of this study was to determine the feasibility and acceptability of a structured morbidity and mortality (M&M) rounds model through an innovative educational intervention. Methods:The authors engaged the Departments of Emergency Medicine (EM) and Trauma Services at a tertiary care teaching hospital. A needs assessment was performed; the Ottawa M&M rounds model was developed, implemented, and then evaluated as a four-part intervention. This consisted of: 1) physician training on case selection and analysis, 2) engaging interprofessional members, 3) disseminating lessons learned, and 4) creating an administrative pathway for acting on issues identified through the M&M rounds. The measures of intervention feasibility included the proportion of sessions adherent to the new model and M&M rounds attendance. Pre-and postintervention surveys of presenters and attendees were used to determine intervention acceptability. M&M presentation content was reviewed to determine the most frequently adopted components of the model. Results:Nine of 14 (64.3%) sessions were adherent to three of four components of the Ottawa M&M Model. Of those M&M attendees who responded to the survey (796 of 912, 87.2%), improvements were found in M&M rounds attendance as well as perceived effect on clinical practice at both individual and departmental levels. Thirty-seven case presentations were analyzed and improvements postintervention were found in appropriate case selection and recognition of cognitive and system issues. Conclusions:The Ottawa M&M Model was a feasible intervention that was perceived to be effective by both presenters and attendees. The authors believe that this could be readily applied to any hospital department seeking to enhance quality of care and patient safety.ACADEMIC EMERGENCY MEDICINE 2014; 21:314-321

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Preventability of trauma deaths in a Dutch Level-1 trauma centre

Cited by 41 publications

References 17 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

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

Enhancing the Quality of Morbidity and Mortality Rounds: The Ottawa M&M Model

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