Time for a Change in Injury and Trauma Care Delivery: A Trauma Death Review Analysis

Abstract

Safety and error reduction in medical care is crucial to the future of medicine. This study evaluates trauma patients dying at a level 1 trauma centre to determine the adequacy of care. All trauma deaths at a level 1 trauma centre between 1996 and 2003 were reviewed by an eight-member multidisciplinary death review panel. Errors in care were classified according to their location, nature, impact, outcome and whether the deaths were avoidable or non-avoidable. Avoidable deaths were categorized as potentially, probably and definitely avoidable. Between 1996 and 2003, there were 17 157 trauma admissions, including 307 trauma deaths. The mean patient age was 47.7 years -24.8 years, mean injury severity score 38.1 -19.6. Of all deaths, 69 (22.5%) were deemed avoidable. Of the avoidable deaths, 61 (88%) were potentially avoidable, 7 (10%) probably avoidable and 1 (1.4%) definitely avoidable. Avoidable deaths were associated with patients with increased age, lower injury severity score, admissions to intensive care unit, longer hospital stay and treatment by a non-trauma surgeon (P < 0.05). Of the 307 trauma deaths, 271 (89.3%) patients experienced a total of 1063 errors, an overall error rate of 3.5 per patient. The error rate in the non-avoidable group was 2.9 per patient and 5.3 per patient in the avoidable group (P < 0.0001). Most errors occurred in the resuscitation area. Age, severity of injury, hospital length of stay and care by a non-trauma surgeon are factors associated with avoidable deaths. A new approach to trauma and injury care is required.

Trauma systems: models of prehospital and inhospital care

“…Similar to Canada, Australian trauma care must meet the challenge of managing patients injured thousands of kilometers from the closest trauma center [6][7][8][9]. 20-30 % of severe trauma cases present initially to a health care facility that is not a trauma center [10,11].…”

“…At present, instead of having a full trauma admission service, trauma services generally have a consultative role [7]. In some hospitals there is a trauma ward for all major trauma admissions.…”

“…The role of the trauma service in this model is to facilitate coordination between the specialties and to encourage continuity of care. While the efficacy of this system has been debated [7,23], the difficulty associated with attracting sufficient specialists to trauma means that this is likely to be the dominant model of definitive surgical care in Australia and New Zealand [7,24]. Several European countries adopt a different approach.…”

“…Residency programs can be terminated if the rules are not followed. In Europe, similar or more rigid limitations have been reinforced [7,25]. Clinicians continue to have major concerns.…”

Study protocol for a framework analysis using video review to identify latent safety threats: trauma resuscitation using in situ simulation team training (TRUST)

“…3 4 6 7 Specifically, delays in diagnosis and management, errors in clinical judgement, technical errors (eg, failure to insert catheter) and procedural errors (eg, failure to perform a step in a standardised protocol) are all frequent causes of preventable deaths in trauma.…”