Patterns of Errors Contributing to Trauma Mortality

Gruen, Russell L.; Jurkovich, Gregory J.; McIntyre, Lisa; Foy, Hugh M.; Maier, Ronald V.

doi:10.1097/01.sla.0000234655.83517.56

Cited by 415 publications

(258 citation statements)

References 29 publications

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“…Gruen ve ark. (3) hastaneye ulaştırıl-mış 2594 politravma hastasında mortaliteye katkıda bulunan hata modellerini saptamaya çalışmışlar, hava yolu güvenliğinin sağlanamaması veya korunamamasının mortaliteye ilişkin en yaygın faktör olduğunu bulmuşlardır.…”

Section: Introductionunclassified

Safely Airway Management in Larinks and Tracheobronchial Injuries

Demirgan¹,

Mingir²,

Kerem³

2017

Okmeydani Medical Journal

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ÖZ GİRİŞTravma, dünyadaki her 10 ölümün yaklaşık 1' ine neden olan önemli ve uluslararası bir sorundur(1) . Bü-yük ölçüde genç nüfusu etkiler. On beş-elli dokuz yaş grubunda, tüm ölümlerin %13-29' undan sorumludur. Travmada ölüm genellikle (%20-86) hastane öncesi ortamda meydana gelir (2) . Özellikle erken ve etkili güvenli hava yolu desteğinin, travmazedelerin yaşamda kalmasını artırabileceğine yönelik çok sayıda teorik ve niceliksel kanıt bulunmaktadır. Hastaneye varmış politravma hastalarının morbidite ve mortalitesi genellikle hava yolu yönetimindeki hatalar sonucu ortaya çıkar. Gruen ve ark.(3) hastaneye ulaştırıl-mış 2594 politravma hastasında mortaliteye katkıda bulunan hata modellerini saptamaya çalışmışlar, hava yolu güvenliğinin sağlanamaması veya korunamamasının mortaliteye ilişkin en yaygın faktör olduğunu bulmuşlardır.Günümüzde, fasiyal travmalar, trafik kazaları, endüstriyel kazalar, silah ve bıçak saldırıları, terör eylemleri ve savaş yaralanmaları nedeniyle oldukça yaygındır (4,5) . Fasiyal yaralanmalar, kafa travması ve hava yolu bütünlüğünde bozulma ile birlikte değilse genellikle yaşamı tehdit etmez. Bu tür hastalarda hava yolu güvenliği ile ilgili başlıca riskler; hastanın hava yolu anatomisinde bulunan kemiklerin parçalanması, yumuşak doku bütünlüğünün bozulması ve aspirasyon pnömonisi insidansının artmasıdır (6) . Travma yönetiminin ABC'lerinin acil serviste yapılmasını sağlamak için ciddi bir fasiyal travma ile uğraşırken multidisipliner yaklaşıma gereksinim duyulmaktadır. Amaç; hava yolu güvenliğinin sağlanması, hastanın solunumunun stabilize edilmesi, kanamanın kontrol edilmesi ve servikal vertebralarda herhangi bir hasar olmadığından emin olmaktır (7) .Supraklavikular bölgede yaralanması olan bir hastada görüntüleme ile aksi ispat edilene kadar servikal vertebra hasarı var olarak kabul edilir (8) . Bilinci yerinde olmayan veya nörolojik defisitli, anormal refleksleri Okmeydanı Tıp Dergisi 33(Ek sayı):

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Section: Introductionunclassified

Safely Airway Management in Larinks and Tracheobronchial Injuries

Demirgan¹,

Mingir²,

Kerem³

2017

Okmeydani Medical Journal

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“…8 The authors reported that delayed intervention for ongoing intrathoracic hemorrhage most often delays the diagnosis of massive hemothorax with inadequate evacuation of blood from chest, or inadequate recognition of the volume that had already been evacuated. 8 The main treatment for life-threatening hemorrhagic shock following blunt thoracic trauma is the rapid control of bleeding. Our findings suggest that thoracotomy should not be excluded solely because of chest tube output that is lower than the traditional criteria.…”

Section: Roc Curves Of 1-h Chest Tube Output For Predicting Thoracotomymentioning

confidence: 99%

“…7 In a study performed at the Harborview Medical Center, patterns of errors contributing to inpatient trauma deaths in a 9-year period were identified. 8 Delayed intervention for ongoing intrathoracic hemorrhage contributed to 9.4% of recognized errors leading to death. 8 The authors reported that delayed intervention for ongoing intrathoracic hemorrhage most often delays the diagnosis of massive hemothorax with inadequate evacuation of blood from chest, or inadequate recognition of the volume that had already been evacuated.…”

Section: Roc Curves Of 1-h Chest Tube Output For Predicting Thoracotomymentioning

confidence: 99%

“…8 Delayed intervention for ongoing intrathoracic hemorrhage contributed to 9.4% of recognized errors leading to death. 8 The authors reported that delayed intervention for ongoing intrathoracic hemorrhage most often delays the diagnosis of massive hemothorax with inadequate evacuation of blood from chest, or inadequate recognition of the volume that had already been evacuated. 8 The main treatment for life-threatening hemorrhagic shock following blunt thoracic trauma is the rapid control of bleeding.…”

Section: Roc Curves Of 1-h Chest Tube Output For Predicting Thoracotomymentioning

confidence: 99%

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Thoracotomy for blunt chest trauma: is chest tube output a useful criterion?

Mizushima¹,

Nakao²,

Watanabe³

et al. 2015

Acute Medicine & Surgery

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Aim:The aim of this study was to determine whether the traditional criteria of chest tube output are useful indicators for urgent thoracotomy in patients with blunt chest trauma.Methods: Data were collected retrospectively from our trauma registry of 542 blunt chest trauma patients (Chest Abbreviated Injury Scale score of 3 or greater) over a 10-year period (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). The 1-h chest tube output was calculated from chest tube output and time after admission, and the results were compared between patients who underwent thoracotomy for hemorrhage and those who did not.Results: Data were available for 24 patients who underwent thoracotomy for hemorrhage and 93 patients who did not undergo thoracotomy. The 1-h chest tube output between the groups was significantly different (708.0 ± 258.3 mL versus 108.9 ± 222.9 mL). Receiver operating characteristic curve analysis of the predictive value of 1-h chest tube output for thoracotomy was conducted. The area under the receiver operating characteristic curve was 0.98, and the cutoff 1-h chest tube output value for predicting thoracotomy was 404 mL (sensitivity, 87.5%; specificity, 96.8%). Conclusions:The 1-h chest tube output of patients who underwent thoracotomy was lower than the thresholds traditionally reported as indications for urgent thoracotomy. High chest tube output as a traditional indicator for thoracotomy may not apply to patients with blunt chest trauma.

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“…The services of protocolbased care, best practices guidelines, ATLS, massive blood transfusion services, advances in haemostasis, investigations, damage control surgeries, and specialist trauma services are all directed at saving patients in this category. [29][30][31] Late trauma deaths, representing the third peak, typically occur days to weeks after initial injury in those that survived the initial insult. This study found 30% of the trauma deaths belong to this category, which is in contrast to 20% described in the original study.…”

Section: Timing Of Deathmentioning

confidence: 99%

Timing of death at National Trauma Center, Abuja, Nigeria

Gwaram¹,

Ameh²

2018

East. Cent. Afr. J. Surg.

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Background: We aimed to analyse the burden and timing of trauma deaths over a 1-year period at a trauma centre in Nigeria.Methods: This was a retrospective review of in-hospital trauma deaths during the period of January to December 2015. Sociodemographic data, cause of injury, mode of presentation, time interval between presentation and death, injury diagnoses, treatment, and place of death were analysed.Results: There were 2230 trauma consultations during the study period; 85 were brought in dead from the scene. We analysed data from 103 of 121 in-hospital deaths. Patient ages ranged from 0 to 90 years, with a mean age of 31.1. The male-to-female ratio was 5:1. Following injury, 46.6% of the victims presented directly to our tertiary centre, while 53.4% were referred from other hospitals. Most of the injuries were from RTA. Isolated head injury was the predominant diagnosis (44.7%), followed by polytrauma (29%). Immediate deaths (exclusive of those brought in already dead) comprised 5.8% of cases; 37.9% were early deaths and 56.3% were late deaths.Conclusions: The timing of trauma deaths closely approximated the original trimodal description in North America about half a century ago even though advances in trauma care have resulted in changes from this pattern in developed countries. Regionalised integrated care including prehospital trauma services are recommended.

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Patterns of Errors Contributing to Trauma Mortality

Abstract: Preventable deaths will occur even in mature trauma systems. This review has identified error patterns that are likely common in all trauma systems, and for which policy interventions can be effectively targeted.

Cited by 415 publications

References 29 publications

Safely Airway Management in Larinks and Tracheobronchial Injuries

Safely Airway Management in Larinks and Tracheobronchial Injuries

Thoracotomy for blunt chest trauma: is chest tube output a useful criterion?

Timing of death at National Trauma Center, Abuja, Nigeria

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