Evaluation of Potentially Preventable Deaths Among Pedestrian and Bicyclist Fatalities

Abstract

The prehospital, emergency department, and in-hospital care of 84 patients who died following a pedestrian- or bicycle-motor vehicle collision in a four-county area was retrospectively reviewed using a systematic, detailed scoring system. The purpose of the study was to examine the effectiveness of an advanced paramedic-regionalized trauma care system and to examine the usefulness of a systematic evaluation tool in identifying preventable and possibly preventable deaths. Among the 84 deaths, one was judged to be preventable and 18 possibly preventable. The one preventable death occurred in the emergency department, while the possibly preventable deaths more commonly occurred after 48 hours and were due to central nervous system injury, sepsis, and multiple organ failure. Prolonged prehospital and emergency department time and failure to establish an airway were the most common problems identified as contributing to fatal outcome. The use of explicit criteria was demonstrated to be an effective addition to the analysis of trauma care systems.

Beneficial effect of helicopter emergency medical services on survival of severely injured patients

“…The possible beneficial effect of the HMT is likely to originate from the additional expertise and therapeutic options brought to the scene. In particular, airway management is a key component of the advanced life support among severely injured patients; failure to achieve adequate airway patency has been identified as a major contributor to preventable death in trauma care28–30.…”

Quality Indicators for Evaluating Trauma Care

“…We identified 103 terms used to identify or describe QIs in our review. Although the field of quality improvement is fundamentally a process of change 10,18,37,49,62,86,109,113,122,140,145,149,151,178,187,194,196,207 ; 3 before-and-after case series 51,118,166 ; 2 nonrandomized controlled trials 16,205 ; and 1 cross-sectional study 17 Hospital mortality a 17 Cohort studies 7,43,49,52,63,83,86,88,105,128,145,149,161,191,192,194,204 73,74,166 ; and 2 case series 42,208 Abbreviations: CT, computed tomography; ED, emergency department. a Includes studies using non-risk-adjusted mortality, risk-adjusted mortality, and statistical outlier deaths.…”

Ethanol Abuse and the Trauma Patient

“…When the systematic analysis of trauma in this country started 20-30 years ago, early trauma centers were able to document substantial variability in outcomes, with up to 30% preventable mortality in many injured patient populations [6]. Institution and maturation of trauma systems throughout the country have standardized the approach to injury, and in most recent analyses there is a low 2-4% preventable death rate [7]. Thus, systematic implementation of standardized acute care has had a dramatic impact on survival [8][9][10][11].…”