Preventable death in trauma: A systematic review on definition and classification

Abstract

Trauma-related preventable death (TRPD) has been used to assess the management and quality of trauma care worldwide. However, due to differences in terminology and application, the definition of TRPD lacks validity. The aim of this systematic review is to present an overview of current literature and establish a designated definition of TRPD to improve the assessment of quality of trauma care. Methods: A search was conducted in PubMed, Embase, the Cochrane Library and the Web of Science Core Collection. Including studies regarding TRPD, published between January 1, 1990, and April 6, 2021. Studies were assessed on the use of a definition of TRPD, injury severity scoring tool and panel review. Results: In total, 3,614 articles were identified, 68 were selected for analysis. The definition of TRPD was divided in four categories: I. Clinical definition based on panel review or expert opinion (TRPD, trauma-related potentially preventable death, trauma-related non-preventable death), II. An algorithm (injury severity score (ISS), trauma and injury severity score (TRISS), probability of survival (Ps)), III. Clinical definition completed with an algorithm, IV. Other. Almost 85% of the articles used a clinical definition in some extend; solely clinical up to an additional algorithm. A total of 27 studies used injury severity scoring tools of which the ISS and TRISS were the most frequently reported algorithms. Over 77% of the panels included trauma surgeons, 90% included other specialist; 61% emergency medicine physicians, 46% forensic pathologists and 43% nurses. Conclusion:The definition of TRPD is not unambiguous in literature and should be based on a clinical definition completed with a trauma prediction algorithm such as the TRISS. TRPD panels should include a trauma surgeon, anesthesiologist, emergency physician, neurologist, and forensic pathologist.

Characteristics of fatal penetrating injury; data from a retrospective cohort study in three urban regions in the Netherlands

“…Trauma-related potentially preventable and preventable death (TRPPD) is used to assess the quality of trauma care (32). TRPPD regard fatalities with severe but survivable injuries if appropriate steps in trauma care had been taken, however, deviations from standard of care led directly or indirectly to the patient's death (21).…”

A Propensity Score-Matched Comparison of In-Hospital Mortality between Dedicated Regional Trauma Centers and Emergency Medical Centers in the Republic of Korea

“…However, there are concerns regarding the reliability of the PTDR. The definition of preventability has not been standardized and differs among studies [ 8 , 28 , 29 ]. Although the World Health Organization (WHO) recommends the utilization of the injury severity score (ISS) and the calculation of the probability of survival in the panel review process, not every study that employed the PTDR utilized objective estimates of survival in determining preventability [ 8 , 10 , 30 ].…”

Classification of trauma-related preventable death; protocol of a Delphi procedure

“…Based on the previously mentioned systematic review the following medical disciplines will be invited to participate in the panel [ 3 ]: 1) Trauma surgery, 2) Neurosurgery, 3) Forensic medicine, 4) Anesthesiology and 5) Emergency Medicine. The Netherlands encounters eleven Level 1 trauma centers [ 12 ].…”

“…Hereby, minimizing social pressure, enabling experts with different backgrounds and geographic locations to participate, whilst adjusting the design of the rounds of enquiry to the requirements of the research subject [ 7 ]. Based on the results of the previously elucidated systematic review the Delphi procedure was judged as most suitable to seek agreement and form consensus on the definition of TRPD by a multidisciplinary expert panel [ 3 , 7 ]. The aim of this study is to present the design of the Delphi procedure on TRPD.…”