Trauma outcomes: A death analysis study

Sugrue, Michael; Seger, Maria; Sloane, D.; Compton, Jan; Hillman, Ken; Deane, S. A.

doi:10.1007/bf02943793

Cited by 33 publications

(15 citation statements)

References 31 publications

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“…In another small study of 38 trauma deaths from Liverpool Hospital in Sydney, Sugrue et al . challenged the validity of the TRISS‐PS 0.5 filter, finding that it had a sensitivity of 67%, specificity of 63%, PPV of 25% and NPV of 91% 7 . McDermott et al .…”

Section: Discussionmentioning

confidence: 99%

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Determining the most effective level of TRISS‐derived probability of survival for use as an audit filter

2002

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Objective: To determine the most effective cut‐off of TRISS‐derived probability of survival (TRISS‐PS) for the selection of trauma deaths for audit, using a large sample of trauma deaths from the United Kingdom (UK). Methods: TRISS‐PS and avoidability of death (as judged by an independent peer review panel) were compared for a sample of 222 trauma deaths. Sensitivity, specificity and predictive values were calculated for the 0.5 screening cut‐off. ROC curves were derived to assess the ability of different levels of TRISS‐PS to identify avoidable deaths. Calculations were made for both the raw sample and the sample adjusted for the sampling method used. Results: For the weight‐adjusted sample, the sensitivity of TRISS‐PS greater than 0.5 for the detection of avoidable death is 80% (95% CI 61–91%), the specificity is 86% (95% CI 80–90%), PPV 42% (95% CI 29–56%) and NPV 97% (95% CI 93–99%). Twenty percent of avoidable deaths would have been ‘missed’ if the 0.5 level of audit filter had been used. Based on the same sample, the best cut‐off is at TRISS‐PS 0.33, with a sensitivity of 90% and specificity of 80%. It is estimated that this cut‐off would have selected 62 deaths for audit and failed to identify 2 out of 25 avoidable deaths. Conclusion: The previously accepted audit filter of TRISS‐PS of greater than 0.5 fails to identify a significant proportion of avoidable deaths. This study suggests that the most effective level of audit filter cut‐off of TRISS‐PS for the trauma system studied is 0.33. This level would identify 90% of avoidable deaths with 80% specificity. Similar ROC curve analysis could be used to determine appropriate TRISS‐PS cut‐offs for institutions or other trauma systems.

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Section: Discussionmentioning

confidence: 99%

“…That study, however, had a small sample with very few patients with TRISS‐PS less than 0.5. Other studies from Australia have questioned this 5–7 …”

Section: Introductionmentioning

confidence: 97%

Determining the most effective level of TRISS‐derived probability of survival for use as an audit filter

2002

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“…(11) Although these are the international standards by which performance is compared, accuracy is restricted and peer review of all deaths is still required. (12) ASCOT is stated to have increased sensitivity in predicting outcome from penetrating trauma. (11,13) There were 7 deaths and 2 were judged to be avoidable by TRISS ( Table 6).…”

Section: Major Trauma Clinical Effectivenessmentioning

confidence: 99%

Lessons from the first operational deployment of emergency medicine

Hodgetts

Kenward

Masud³

2000

J R Army Med Corps

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The first operational deployment of emergency medicine in the UK Defence Medical Services was in support of a 50-bed field hospital during OP AGRICOLA, Kosovo, from 25 June-26 August 1999. In preparation, new equipment scales were designed to extend the traditional surgical-based approach to the reception of patients. The organisation of the front end of a field hospital was modified to reflect the current UK peace-time practice of emergency medicine. Specialist emergency medicine trained doctors and nurses provided the core personnel. 1189 patients were treated in the 2-month deployment. 903 were KFOR troops (862 BRITFOR), 187 Kosovo-Albanian, 69 Serbian and 30 derived from United Nations or nongovernment organisations. There were 63 resuscitations, with 21 relating to KFOR troops. 42 patients met the criteria for a trauma team activation; age was 33.4 ± 18.7 years (mean ± SD). Mean Injury Severity Score (ISS) was 16.3 ± 18.6; mean New Injury Severity Score (NISS) was 22.5 ± 20.5. 14 of 42 were ‘major trauma’ characterised by ISS ≥16; 22 had a NISS ≥16. 36% of the major trauma by ISS was gunshot wound (GSW), 7% blast and fragmentation, and 57% blunt; age was 33.3 ± 20.4 years (mean ± SD for ISS ≥16 group). Standardised Mortality Ratio was 1.50. The Effectiveness E value for outcome was 0.85. NISS detected 3 further patients with GSW, 3 with blast/fragmentation, and 2 with blunt injury. A diverse range of medical emergencies was encountered. The extended role of the emergency physician was exploited to include coordination of major trauma audit and clinical feedback, local and national disaster planning, and co-ordination of humanitarian support to design, build and equip an emergency department at the University Hospital of Pristina. The operational value of emergency medicine within UK Defence Medical Services has been firmly established.

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“…All trauma patients with overt or occult shock are presumed to be suffering from hemorrhagic shock until proven otherwise. 1,2 Empirical criteria for diagnosis of circulatory shock regardless of the cause, four of these six criteria should be met:…”

Section: Introductionmentioning

confidence: 99%

Detection of medical errors in management of traumatic hypovolemic shocked adult patients presented to emergency department in Suez Canal university hospital, Ismailia, Egypt

et al. 2016

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Background: IN 2010, Institute of Medicine in USA report that medical errors are estimated to result in about between 44,000 and 98,000 preventable deaths and 1,000,000 excess injuries each year in U.S. hospitals. The annual cost of treating medical injuries in USA has been estimated to be $9 billion. The objective of this study was to follow up guidelines in treatment of Traumatic hypovolemic shocked patients. Methods: The design of this study is a cross sectional descriptive study was conducted on traumatic patients who presented to the emergency department between the periods from October 2012 to October 2013. This study was conducted at the emergency department Suez Canal University Hospital, Ismailia, Egypt. On 100 patients with traumatic hypovolemic shock male or female within the age ranges from 18 years till 65 years old. Patients admitted to the hospital with other types of shock with trauma, non-traumatic hypovolemic shock, pregnant females, advanced malignancy, patients below 18 years old or patients more than 65 years old should excluded from the study. Questionnaire was filled by the researcher during resuscitation of the patient diagnosed as traumatic hypovolemic shock by the medical team in details; medical error was identified by comparing the actual management plan to the standard plan according to the guidelines from "The Washington manual of critical care". Results: This study was conducted on 100 patients who presented to the Emergency Department, Seuz Canal University Hospital, Ismailia, Egypt. Between the period from October 2012 to October 2013 in order to detect medical errors in treatment of Traumatic hypovolemic shocked patients and to reach the optimal scheme of management. 1-More than half of the patients were in age group (≥30-45). And most of them were males about 70% of the studied patients and females were 30%. 2-Most of the patients were delayed in hospital arrival as we found that 50% reached in more than 40 min. 3-The initial medical help in the pre-hospital period was given to almost all of the patients (94%). 4-Incomplete exposure of patients is a very frequent medical error occurs during hospital assessment in about 22% of patients. Conclusions: Failure in oxygen saturation monitoring and forgetting complete exposure of the patient has statistically significant relation with mortality during in hospital assessment of the patient. Delayed insertion of 2 large cannula or central line, Fluid given not warmed and blood received not at the proper time all of them show statistically significant Relation with mortality during in hospital resuscitation of the patient with traumatic hypovolemic shock.

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Trauma outcomes: A death analysis study

Cited by 33 publications

References 31 publications

Determining the most effective level of TRISS‐derived probability of survival for use as an audit filter

Determining the most effective level of TRISS‐derived probability of survival for use as an audit filter

Lessons from the first operational deployment of emergency medicine

Detection of medical errors in management of traumatic hypovolemic shocked adult patients presented to emergency department in Suez Canal university hospital, Ismailia, Egypt

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