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Hakkenbrak NAG, Mikdad SY, Zuidema WP, Halm JA, Schoonmade LJ, Reijnders UJL, Bloemers FW, Giannakopoulos GF. Preventable death in trauma: A systematic review on definition and classification. Injury 2021; 52:2768-2777. [PMID: 34389167 DOI: 10.1016/j.injury.2021.07.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE 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.
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Affiliation(s)
- N A G Hakkenbrak
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands.
| | - S Y Mikdad
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - W P Zuidema
- Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - J A Halm
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - L J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, the Netherlands
| | - U J L Reijnders
- Department of Forensic Medicine, Public Health Service of Amsterdam, the Netherlands
| | - F W Bloemers
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands
| | - G F Giannakopoulos
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
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American vs. European Trauma Centers: A Comparison of Preventable Deaths. Cir Esp 2017; 95:457-464. [PMID: 28947102 DOI: 10.1016/j.ciresp.2017.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/21/2017] [Accepted: 07/27/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The aim is comparing the quality of care at a typical American trauma center (USC) vs. an equivalent European referral center in Spain (SRC), through the analysis of preventable and potentially preventable deaths. METHODS Comparative study that evaluated trauma patients older than 16 years old who died during their hospitalization. We cross-referenced these deaths and extracted all deaths that were classified as potentially preventable or preventable. All errors identified were then classified using the JC taxonomy. RESULTS The rate of preventable and potentially preventable mortality was 7.7% and 13.8% in the USC and SRC respectively. According to the JC taxonomy, the main error type was clinical in both centers, due to errors in intervention (treatment). Errors occurred mostly in the emergency department and were caused by physicians. In the USC, 73% of errors were therapeutic as compared to 59% in the SRC (P=.06). The SRC had a 41% of diagnosis errors vs just 18% in the USC (P = .001). In both centers, the main cause of error was human. At the USC, the most frequent human cause was 'knowledge-based' (44%). In contrast, at the SRC center the most common errors were 'rule-based' (58%) (P<.001). CONCLUSIONS The use of a common language of errors among centers is key in establishing benchmarking standards. Comparing the quality of care of an American trauma center and a Spanish referral center, we have detected remarkably similar avoidable errors. More diagnostic and 'ruled-based' errors have been found in the Spanish center.
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Ha M, Kim BC, Choi S, Cho WH, Choi HJ. Preventable and Potentially Preventable Traumatic Death Rates in Neurosurgery Department: A Single Center Experience. Korean J Neurotrauma 2016; 12:67-71. [PMID: 27857910 PMCID: PMC5110921 DOI: 10.13004/kjnt.2016.12.2.67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/01/2016] [Accepted: 09/30/2016] [Indexed: 11/15/2022] Open
Abstract
Objective Preventable and potentially preventable traumatic death rates is a method to evaluate the preventability of the traumatic deaths in emergency medical department. To evaluate the preventability of the traumatic deaths in patients who were admitted to neurosurgery department, we performed this study. Methods A retrospective review identified 52 patients who admitted to neurosurgery department with severe traumatic brain injuries between 2013 and 2014. Based on radiologic and clinical state at emergency room, each preventability of death was estimated by professional panel discussion. And the final death rates were calculated. Results The preventable and potentially preventable traumatic death rates was 19.2% in this study. This result is lower than that of the research of 2012, Korean preventable and potentially preventable traumatic death rates. The rate of preventable and potentially preventable traumatic death of operation group is lower than that of conservative treatment group. Also, we confirmed that direct transfer and the time to operation are important to reduce the preventability. Conclusion We report the preventable and potentially preventable traumatic death rates of our institute for evaluation of preventability in severe traumatic brain injuries during the last 2 years. For decrease of preventable death, we suggest that continuous survey of the death rate of traumatic brain injury patients is required.
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Affiliation(s)
- Mahnjeong Ha
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Byung Chul Kim
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Seonuoo Choi
- Department of Trauma Surgery, Trauma Center of Pusan National University Hospital, Busan, Korea
| | - Won Ho Cho
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
| | - Hyuk Jin Choi
- Department of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea
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Ryan JM, Roberts P. Definitive surgical trauma skills: a new skills course for specialist registrars and consultants in general surgery in the United Kingdom. TRAUMA-ENGLAND 2016. [DOI: 10.1191/1460408602ta240oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In an era of increasing subspecialization within UK surgical practice, few senior trainees and a diminishing number of consultants feel competent operating outside their chosen specialist eld. General surgery and orthopaedic trainees, however, remain in the front line of trauma management. Subspecialization is, to some degree, affecting training of orthopaedic surgeons; there are some that do not deal with trauma. However, it is in the so-called field of general surgery that subspecialization has had the greatest impact. Many trainees are now more familiar with endoscopic techniques than open laparotomy and, even within the open abdomen, few wish to explore organ systems or regions outside their `zone of comfort’. Trauma, especially that inflicted by rearms, does not respect anatomical or speciality boundaries. This raises the question of how best to train surgeons in the future to manage severe multisystem injury. To manage trauma competently there is a need to master operative skills that cover the whole of the abdominal cavity, including the pelvis and the retroperitoneum. General surgeons should be competent and confident to carry out trauma thoracotomies and able to cope with central and peripheral vascular trauma. Further skills and knowledge are also required: these encompass trauma epidemiology, critical decision making and, not least, a detailed knowledge of surgical anatomy. Knowledge can be most severely tested when dealing with multi-system trauma! There is also a particular need to give military surgeons the competencies required to deal with battlefield trauma, 90% of which is caused by penetrating injury. Military surgeons, by definition, still need to be `generalists’. The Raven department of education at the Royal College of Surgeons of England, the Royal Defence Medical College (now the Royal Centre for Defence Medicine, Birmingham), and the Uniformed Services University of the Health Sciences, Washington, have developed a Definitive Surgical Trauma Skills (DSTS) course to meet this specific training need. This tripartite venture was developed in association with the Societe International de Chirugie (SIC) and the International Association for the Surgery of Trauma and Surgical Intensive Care (IATSIC).
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Affiliation(s)
- JM Ryan
- Raven Department of Education, Royal College of Surgeons of England, London, UK,
| | - P Roberts
- Raven Department of Education, Royal College of Surgeons of England, London, UK
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Montmany S, Pallisera A, Rebasa P, Campos A, Colilles C, Luna A, Navarro S. Preventable deaths and potentially preventable deaths. What are our errors? Injury 2016; 47:669-73. [PMID: 26686593 DOI: 10.1016/j.injury.2015.11.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/07/2015] [Accepted: 11/16/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND A variety of systems have been applied to identify and address errors in the management of multiple trauma patients. This lack of standardisation represents a serious problem. OBJECTIVES Detect preventable and potentially preventable deaths, and classify all the errors with universal language. METHODS We studied all trauma patients over 16 admitted to the critical care unit or who died before. In multidisciplinary sessions we decided which deaths were preventable, potentially preventable and non preventable. Guided by ATLS protocols, we detected errors in their management that were classified using the taxonomy of Joint Commission. RESULTS We registered 1236 trauma patients (ISS 20.77). Of the 115 trauma deaths, 19 were preventable or potentially preventable deaths. We recorded 130 errors in all deaths, 46 of them in preventable or potentially preventable deaths. Using our own classification, the main errors were delay in starting correct treatment or performance of CT in hemodynamically unstable patients. Using the taxonomy of Joint Commission, the main type error was clinical, during the intervention: the delay in initiating correct treatment. Mistakes were made in the emergency department by medical specialists. The incidence of therapeutic and diagnostic errors was similar. The main cause of error was human failure, specifically 'rule-based' errors CONCLUSIONS Measuring and recording the results is the first step on the way to improving the quality of care for trauma patients. A common language like the taxonomy of Joint Commission will help standardise patient safety data, thus improving the recording of incidents and their analysis and treatment.
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Affiliation(s)
- Sandra Montmany
- General Surgery, Hospital Universitari Parc Taulí, C. Sant Llorenç, 14-1r1a, 08202 Sabadell, Spain.
| | - Anna Pallisera
- General Surgery, Fundación Hospital Son Llàtzer, Carretera de Manacor, 4, 07198 Son Ferriol, Islas Baleares, Spain.
| | - Pere Rebasa
- General Surgery, Hospital Universitari Parc Taulí, Parc Taulí, s/n, 08208 Sabadell, Spain.
| | - Andrea Campos
- General Surgery, Hospital Universitari Parc Taulí, Parc Taulí, s/n, 08208 Sabadell, Spain.
| | - Carme Colilles
- Anesthesiology, Hospital Universitari Parc Taulí, Parc Taulí, s/n, 08208 Sabadell, Spain.
| | - Alexis Luna
- General Surgery, Hospital Universitari Parc Taulí, Parc Taulí, s/n, 08208 Sabadell, Spain.
| | - Salvador Navarro
- General Surgery, Hospital Universitari Parc Taulí, Parc Taulí, s/n, 08208 Sabadell, Spain.
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Moon S, Lee SH, Ryoo HW, Kim JK, Ahn JY, Kim SJ, Jeon JC, Lee KW, Sung AJ, Kim YJ, Lee DR, Do BS, Park SR, Lee JS. Preventable trauma death rate in Daegu, South Korea. Clin Exp Emerg Med 2015; 2:236-243. [PMID: 27752603 PMCID: PMC5052913 DOI: 10.15441/ceem.15.085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/15/2015] [Accepted: 10/18/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE This study investigated the preventable death rate in Daegu, South Korea, and assessed affecting factors and preventable factors in order to improve the treatment of regional trauma patients. METHODS All traumatic deaths between January 2012 and December 2012 in 5 hospitals in Daegu were analyzed by panel review, which were classified into preventable and non-preventable deaths. We determined the factors affecting trauma deaths and the preventable factors during trauma care. RESULTS There were overall 358 traumatic deaths during the study period. Two hundred thirty four patients were selected for the final analysis after excluding cases of death on arrival, delayed death, and unknown causes. The number of preventable death was 59 (25.2%), which was significantly associated with mode of arrival, presence of head injury, date, and time of injury. A multivariate analysis revealed that preventable death was more likely when patients were secondly transferred from another hospital, visited hospital during non-office hour, and did not have head injuries. The panel discovered 145 preventable factors, which showed that majority of factors occurred in emergency departments (49.0%), and were related with system process (76.6%). CONCLUSION The preventable trauma death rate in Daegu was high, and mostly process-related.
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Affiliation(s)
- Sungbae Moon
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Suk Hee Lee
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jong Kun Kim
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Yun Ahn
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sung Jin Kim
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Jae Cheon Jeon
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Kyung Woo Lee
- Department of Emergency Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Ae Jin Sung
- Department of Emergency Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Yun Jeong Kim
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Dae Ro Lee
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Korea
| | - Byung Soo Do
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Sin Ryul Park
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jin-Seok Lee
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
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Pooled preventable death rates in trauma patients. Eur J Trauma Emerg Surg 2014; 40:279-85. [DOI: 10.1007/s00068-013-0364-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 12/29/2013] [Indexed: 10/25/2022]
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Vähäaho S, Söderlund T, Tulikoura I, Reitala J, Niemelä M, Handolin L. Traumatic deaths at hospital: analysis of preventability and lessons learned. Eur J Trauma Emerg Surg 2014; 40:707-13. [PMID: 26814786 DOI: 10.1007/s00068-013-0372-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 12/30/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of the present study was to characterize traumatic deaths of major trauma patients occurring in a university trauma centre and to assess retrospectively the quality of given care by evaluating whether any of the deaths could be identified as potentially preventable. METHODS All consecutive deaths of trauma patients between January 1, 2004 and December 31, 2008 in the Töölö Hospital Trauma Centre were retrospectively reviewed. The inclusion criterion was death of a trauma patient occurring during stay at hospital. Patients aged >65 years with an isolated proximal femoral fracture, burn patients, patients with isolated limb fracture other than femoral or tibial shaft fracture, and patients with isolated traumatic brain injuries were excluded as well as patients admitted more than 24 h after injury. RESULT A total of 130 patients fulfilled the inclusion criteria. The autopsy reports were obtained for 103 of the cases (80.4 %). The majority of the patients were male, and the median age was 58 years (range 1-95 years). Blunt trauma was the most common type of injury. The most common injury mechanisms were fall from a higher level (31 %), fall from the level of the patient (21 %), and motor vehicle accident (17 %). Of the injuries not diagnosed before autopsy, the most common were liver lacerations, rib fractures, pulmonary contusions, sternum fractures, and blunt cardiac injuries. In our study population 12.5 % of the cases were considered potentially preventable. The reasons for preventability were inadequate treatment of coagulopathy, overuse of opioid medication, and loss of airway as well as failing to treat impending pneumonia and DVT. Trauma resuscitation was inadequate in 7.8 % of the cases. CONCLUSIONS The most common error made was not recognising and treating traumatic coagulopathy adequately.
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Affiliation(s)
- S Vähäaho
- Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Central Hospital, Helsinki, Finland.
- Department of Surgery, Jorvi Hospital, Helsinki University Central Hospital, Turuntie 150, Espoo, P.O. Box 800, 00029, HUS, Finland.
| | - T Söderlund
- Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - I Tulikoura
- Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - J Reitala
- Department of Anesthesiology and Intensive Care Medicine, Töölö Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - M Niemelä
- Department of Neurosurgery, Töölö Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - L Handolin
- Department of Orthopedics and Traumatology, Töölö Hospital, Helsinki University Central Hospital, Helsinki, Finland
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Miranda JJ, Rosales-Mayor E, Quistberg DA, Paca-Palao A, Gianella C, Perel P, Lopez L, Luna D, Best P, Huicho L. Patient perspectives on the promptness and quality of care of road traffic incident victims in Peru: a cross-sectional, active surveillance study. F1000Res 2013; 2:167. [PMID: 24358877 PMCID: PMC3814912 DOI: 10.12688/f1000research.2-167.v1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2013] [Indexed: 11/22/2022] Open
Abstract
Background: Road injuries are the second-leading cause of disease and injury in the Andean region of South America. Adequate management of road traffic crash victims is important to prevent and reduce deaths and serious long-term injuries. Objective: To evaluate the promptness of health care services provided to those injured in road traffic incidents (RTIs) and the satisfaction with those services during the pre-hospital and hospital periods. Methods: We conducted a cross-sectional study with active surveillance to recruit participants in emergency departments at eight health care facilities in three Peruvian cities: a large metropolitan city (Lima) and two provincial cities (an urban center in the southern Andes and an urban center in the rainforest region), between August and September 2009. The main outcomes of interest were promptness of care, measured by time between injury and each service offered, as well as patient satisfaction measured by the Service Quality (SERVQUAL) survey. We explored the association between outcomes and city, type of health care facility (HCF), and type of provider. Results: We recruited 644 adults seeking care for RTIs. This active surveillance strategy yielded 34% more events than anticipated, suggesting under-reporting in traditional registries. Median response time between a RTI and any care at a HCF was 33 minutes overall and only 62% of participants received professional care during the initial “golden” hour after the RTI. After adjustment for various factors, there was strong evidence of higher global dissatisfaction levels among those receiving care at public HCFs compared to private ones (odds ratio (OR) 5.05, 95% confidence interval (CI) 1.88-13.54). This difference was not observed when provincial sites were compared to Lima (OR 1.41, 95% CI 0.42-4.70). Conclusions: Response time to RTIs was adequate overall, though a large proportion of RTI victims could have received more prompt care. Overall, dissatisfaction was high, mainly at public institutions indicating much need for improvements in service provision.
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Affiliation(s)
- J Jaime Miranda
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; CRONICAS, Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru ; EDHUCASALUD, Asociación Civil para la Educación en Derechos Humanos con Aplicación en Salud, Lima, Peru
| | - Edmundo Rosales-Mayor
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; Centro de Trastornos Respiratorios del Sueño (CENTRES), Clínica Anglo Americana, Lima, Peru ; Grupo de Investigación en Sueño (GIS), Lima, Peru ; Hospital Clínic de Barcelona, Barcelona, 08036, Spain
| | - D Alex Quistberg
- Department of Epidemiology, School of Public Health, University of Washington, Seattle WA, 98195-7236, USA ; Harborview Injury Prevention & Research Center (HIPRC), University of Washington, Seattle WA, 98104-2499, USA
| | - Ada Paca-Palao
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru
| | - Camila Gianella
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; EDHUCASALUD, Asociación Civil para la Educación en Derechos Humanos con Aplicación en Salud, Lima, Peru
| | - Pablo Perel
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Luis Lopez
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; Dirección de Formación Profesional y los Recursos Humanos, Ministerio del Trabajo y Promoción del Empleo, Lima, Peru
| | - Diego Luna
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; Departamento de Ciencias Sociales y Políticas, Universidad del Pacífico, Lima, Peru ; Asociación Civil, Gobierno Coherente, Lima, Peru
| | - Pablo Best
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Huicho
- Programa de Investigación en Accidentes de Tránsito, Salud Sin Límites Perú, Lima, Peru ; School of Medicine, Universisdad Peruana Cayetano Heredia, Lima, Peru ; Department of Pediatrics, Instituto Nacional de Salud del Niño, Lima, Peru ; School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
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Rosales-Mayor E, Miranda JJ, Lema C, López L, Paca-Palao A, Luna D, Huicho L. [Resources and capacity of emergency trauma care services in Peru]. CAD SAUDE PUBLICA 2012; 27:1837-46. [PMID: 21986611 DOI: 10.1590/s0102-311x2011000900017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 06/27/2011] [Indexed: 11/21/2022] Open
Abstract
The objectives of this study were to evaluate the resources and capacity of emergency trauma care services in three Peruvian cities using the WHO report Guidelines for Essential Trauma Care. This was a cross-sectional study in eight public and private healthcare facilities in Lima, Ayacucho, and Pucallpa. Semi-structured questionnaires were applied to the heads of emergency departments with managerial responsibility for resources and capabilities. Considering the profiles and volume of care in each emergency service, most respondents in all three cities classified their currently available resources as inadequate. Comparison of the health facilities showed a shortage in public services and in the provinces (Ayacucho and Pucallpa). There was a widespread perception that both human and physical resources were insufficient, especially in public healthcare facilities and in the provinces.
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Abstract
OBJECTIVE Multiple quality indicators are available to evaluate adult trauma care, but their characteristics and outcomes have not been systematically compared. We sought to systematically review the evidence about the reliability, validity, and implementation of quality indicators for evaluating trauma care. DATA SOURCES Search of MEDLINE, EMBASE, CINAHL, and The Cochrane Library up to January 14, 2009; the Gray Literature; select journals by hand; reference lists; and articles recommended by experts in the field. STUDY SELECTION Studies were selected that evaluated the reliability, validity, or the impact of one or more quality indicators on the quality of care delivered to patients ≥ 18 yrs of age with a major traumatic injury. DATA EXTRACTION Reviewers with methodologic and content expertise conducted data extraction independently. DATA SYNTHESIS The literature search identified 6869 citations. Review of abstracts led to the retrieval of 538 full-text articles for assessment; 40 articles were selected for review. Of these, 20 (50%) articles were cohort studies and 13 (33%) articles were case series. Five articles used control groups, including three before and after case series, a case-control study, and a nonrandomized controlled trial. A total of 115 quality indicators in adult trauma care was identified, predominantly measures of hospital processes (62%) and outcomes (17%) of care. We did not identify any posthospital or secondary injury prevention quality indicators. Reliability was described for two quality indicators, content validity for 22 quality indicators, construct validity for eight quality indicators, and criterion validity for 46 quality indicators. A total of 58 quality indicators was implemented and evaluated in three studies. Eight quality indicators had supporting evidence for more than one measurement domain. A single quality indicator, peer review for preventable death, had both reliability and validity evidence. CONCLUSIONS Although many quality indicators are available to measure the quality of trauma care, reliability evidence, validity evidence, and description of outcomes after implementation are limited.
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Wisborg T, Brattebø G, Brinchmann-Hansen A, Hansen KS. Mannequin or standardized patient: participants' assessment of two training modalities in trauma team simulation. Scand J Trauma Resusc Emerg Med 2009; 17:59. [PMID: 19939247 PMCID: PMC2789037 DOI: 10.1186/1757-7241-17-59] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 11/25/2009] [Indexed: 11/17/2022] Open
Abstract
Background Trauma team training using simulation has become an educational compensation for a low number of severe trauma patients in 49 of Norway's 50 trauma hospitals for the last 12 years. The hospitals' own simple mannequins have been employed, to enable training without being dependent on expensive and advanced simulators. We wanted to assess the participants' assessment of using a standardized patient instead of a mannequin. Methods Trauma teams in five hospitals were randomly exposed to a mannequin or a standardized patient in two consecutive simulations for each team. In each hospital two teams were trained, with opposite order of simulation modality. Anonymous, written questionnaires were answered by the participants immediately after each simulation. The teams were interviewed as a focus group after the last simulation, reflecting on the difference between the two simulation modalities. Outcome measures were the participants' assessment of their own perceived educational outcome and comparison of the models, in addition to analysis of the interviews. Results Participants' assessed their educational outcome to be high, and unrelated to the order of appearance of patient model. There were no differences in assessment of realism and feeling of embarrassment. Focus groups revealed that the participants felt that the choice between educational modalities should be determined by the simulated case, with high interaction between team and patient being enhanced by a standardized patient. Conclusion Participants' assessment of the outcome of team training seems independent of the simulation modality when the educational goal is training communication, co-operation and leadership within the team.
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Affiliation(s)
- Torben Wisborg
- The BEST Foundation: Better & Systematic Trauma Care, Hammerfest Hospital, Department of Acute Care, Hammerfest, Norway.
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Uleberg O, Vinjevoll OP, Eriksson U, Aadahl P, Skogvoll E. Overtriage in trauma - what are the causes? Acta Anaesthesiol Scand 2007; 51:1178-83. [PMID: 17714579 DOI: 10.1111/j.1399-6576.2007.01414.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Different criteria are employed to activate trauma teams. Because of a growing concern about overtriage, the objective of this study was to investigate the performance of our trauma team's activation protocol. METHODS Injured patients with trauma team activation (TTA), admission to an intensive care unit or surgical intermediate care unit with a trauma diagnosis, or trauma-related death in the emergency department were investigated retrospectively from 1 January 2004 to 31 December 2005. Different TTA criteria were analysed with respect to sensitivity, positive predictive value (PPV) and overtriage (1 - PPV). RESULTS Eight hundred and nine patients were included, 185 (23%) of whom had an Injury Severity Score (ISS) of more than 15. The performance of our protocol showed a sensitivity of 87%, PPV of 22% and overtriage of 78%. The mechanism of injury as a TTA criterion had a sensitivity of 14%, PPV of 7% and overtriage of 93%. Physiological/anatomical criteria and interfacility transfer showed higher PPV and less overtriage. Undertriage (no TTA despite ISS > 15) was identified in 23 patients (13%), 18 of whom were hospital transfers. CONCLUSION A TTA protocol based on physiological, anatomical and interfacility transfer criteria seems to yield a higher precision than, in particular, that based on mechanism of injury criteria. Because of substantial overtriage in our hospital, the TTA protocol needs to be re-evaluated.
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Affiliation(s)
- O Uleberg
- Department of Anaesthesia and Intensive Care, St. Olav's University Hospital and Norwegian University of Science and Technology, Trondheim, Norway.
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Gilroy D. Deaths from blunt trauma, after arrival at hospital: plus ça change, plus c'est la même chose. Injury 2005; 36:47-50. [PMID: 15589912 DOI: 10.1016/j.injury.2004.04.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2004] [Indexed: 02/02/2023]
Abstract
In this retrospective review of 94 deaths from blunt trauma occurring after admission to the hospital, in the region of Northern Ireland, for the year of 2001, data is presented with reference to preventable deaths (10%). Comparison is made with previous audit from the year of 1981 (preventable death rate 16%). Adverse events continue to occur in relation to abdominal haemorrhage, and issues pertaining to multidisciplinary care.
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Affiliation(s)
- D Gilroy
- Whiteabbey Hospital, Newtownabbey, Belfast, County Antrim BY37 9RH, UK.
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15
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Abstract
Complex fractures are generally assumed by our profession to require adequate training and continuing practice to treat optimally. The quantity of complex fractures treated in individual hospitals and by or under the care of individual orthopaedic consultants may have implications regarding the quality of care for particular patients and also for the training of specialist registrars.A complex fracture was defined as a comminuted peri- or intra-articular fracture or segmental shaft fracture: fractures acknowledged at specialist fracture courses and by special trauma surgeons to require particular training and experience to treat optimally. The AO classification was used: most fractures were in AO groups B and C [M.E. Muller, S. Narazian, P. Koch, J. Schatzker, The Comprehensive Classification of Longbones, Springer, Berlin, 1990]. Theatre records were used to identify all operated orthopaedic trauma cases over a period of 1 year in one District General Hospital (DGH) and one University Hospital, each serving populations of over 300000 and for 6 months in one DGH (population approximately 300000). Radiographs and hospital records were reviewed by two orthopaedic surgeons and the number and type of complex fractures documented as defined above. In hospital A, 69 complex fracture operations were carried out under the care of six consultants in 12 months. In hospital B, 24 complex fractures were treated by five consultants over a 6-month period and in hospital C, 127 complex fractures were treated by 10 consultants over a 12-month period. Some consultants (different consultants for different fracture regions) did not operate on any complex fracture of the proximal, mid, or distal humerus; proximal, mid, or distal radius or ulna; proximal, mid, or distal femur; proximal, mid, or distal tibia; calcaneum; peri-prosthetic; Lisfranc; or talus fracture during the specific time period. Some consultants only treated one or two such fractures. Where two surgeons had developed an area of special interest and cross-referral were encouraged individual surgeons were operating on up to 25 complex cases in their area of interest.This audit has shown that individual complex fractures present infrequently to particular hospitals and surgeons. This finding raises questions about the optimal management of such fractures: are we maintaining a sufficient level of expertise, or should there be more cross-referrals to surgeons with a specific interest either in trauma or in a particular anatomical region?
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Affiliation(s)
- L Cutler
- Department of Orthopaedics and Trauma, Warrington General Hospital, Lovely Lane, Warrington WA5 1QG, UK
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Zafarghandi MR, Modaghegh MHS, Roudsari BS. Preventable Trauma Death in Tehran: An Estimate of Trauma Care Quality in Teaching Hospitals. ACTA ACUST UNITED AC 2003; 55:459-65. [PMID: 14501887 DOI: 10.1097/01.ta.0000027132.39340.fe] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was estimate the number of preventable trauma deaths in teaching hospitals in Tehran. METHODS We evaluated the complete prehospital, hospital, and postmortem data of 70 trauma patients who had died during a 1-year period in two of the largest university hospitals in Tehran with a multidisciplinary panel of experts. RESULTS Panel members identified 26% of all trauma deaths as preventable deaths. From 31 non-central nervous system-related deaths, 17 and 6 cases were identified as surely preventable and probably preventable, respectively. In central nervous system-related deaths, 5% of the deaths overall (2 of 38 cases) were identified as surely preventable or probably preventable. Sixty-four cases of medical errors were identified in 31 trauma deaths and 80% of these errors were directly related to the death of the patients. CONCLUSION The high preventable trauma death rate in our teaching hospitals indicates that a relatively significant percentage of trauma fatalities could have been prevented by improving prehospital and in-hospital trauma care.
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Affiliation(s)
- Mohammad-Reza Zafarghandi
- Department of Vascular Surgery, and Sina Trauma Research Center, Tehran University of Medcial Sciences, Tehran, Iran.
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17
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Chiara O, Scott JD, Cimbanassi S, Marini A, Zoia R, Rodriguez A, Scalea T. Trauma deaths in an Italian urban area: an audit of pre-hospital and in-hospital trauma care. Injury 2002; 33:553-62. [PMID: 12208056 DOI: 10.1016/s0020-1383(02)00123-7] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In Italy, a comprehensive regional study of trauma deaths has never been performed. We examined the organization and delivery of trauma care in the city area of Milan, using panel review of trauma deaths. Two panels evaluated the appropriateness of care of all trauma victims occurred during 1 year, applying predefined criteria and judging deaths as not preventable (NP), possible preventable (PP), and definitely preventable (DP). Two hundred and fifty-five deaths were reviewed. Blunt trauma were 78.04% and motor vehicle crashes accounted for over 50%. Most victims (73.72%) died during pre-hospital settings and 91.1% died within the first 6h, principally because of central nervous system injuries in blunt and hemorrhage in penetrating trauma. Panels judged 57% of deaths NP, 32% PP, 11% DP (inter-panel K-test 0.88). Preventable deaths were higher after in-hospital admission. Main failures of treatment were lack in airway control or intravenous infusions in pre-hospital and mismanagement with missed injuries in emergency department. The high rate of avoidable deaths in Milan supports the need of trained pre-hospital personnel and of well equipped referring hospitals for trauma.
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Affiliation(s)
- Osvaldo Chiara
- Istituto di Chirurgia d'Urgenza, Università degli Studi di Milano-IRCCS Ospedale, Maggiore, via Francesco Sforza 35, 20122, Milan, Italy.
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Norris R, Woods R, Harbrecht B, Fabian T, Rhodes M, Morris J, Billiar TR, Courcoulas AP, Udekwu AO, Stinson C, Peitzman AB. TRISS unexpected survivors: an outdated standard? THE JOURNAL OF TRAUMA 2002; 52:229-34. [PMID: 11834980 DOI: 10.1097/00005373-200202000-00005] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Performance improvement is an essential component of the trauma center. TRISS methodology has been applied as a national standard against which trauma centers can compare their outcomes. Earlier reviews of TRISS unexpected survivors sustained the classification of unexpected survivor in the vast majority of cases. Our hypothesis was that the level of care that is currently expected has made the TRISS unexpected survivors a statistical phenomenon only. METHODS Two hundred seventy TRISS unexpected survivors at a Level I trauma center from 1991 to 1995 were reviewed. Each case was reviewed as a blinded abstract by six reviewers (three of whom are directors at other facilities) and classified as clinically unexpected survivor (confirmed TRISS classification) or clinically expected survivor (did not sustain TRISS classification as unexpected survivor). Data are expressed as mean +/- SD. Statistical significance was achieved at p < 0.05. RESULTS Among the 270 patients categorized by TRISS as unexpected survivors, only 10.7% were corroborated as clinically unexpected survivors by this peer review process and 89.3% were reclassified as clinically expected survivors. Confirmed clinically unexpected survivors were more likely to go directly from the emergency department to the operating room (82 vs. 46%; p < 0.05). Age (32 +/- 12 years vs. 40 +/- 19 years; p < 0.05), Injury Severity Score (46 +/- 20 vs. 32 +/- 14; p < 0.05), Revised Trauma Score (2.46 +/- 1.89 vs. 3.11 +/- 1.21; p < 0.05), probability of survival (0.13 +/- 0.13 vs. 0.24 +/- 0.15; p < 0.05), systolic blood pressure in the emergency department (60 +/- 51 mm Hg vs. 109 +/- 33 mm Hg; p < 0.05), hospital length of stay (39.6 +/- 30.3 days vs. 24.0 +/- 23.0 days; p < 0.05), and intensive care unit length of stay (19.5 +/- 20.6 days vs. 9.6 +/- 10.1 days; p < 0.05) were significantly different comparing confirmed versus unsustained classification as unexpected survivors. CONCLUSION Only 10.7% of survivors classified as unexpected by TRISS were corroborated as unexpected by a blinded, peer-review process. TRISS needs to be updated for meaningful interpretation; modifications need to be made and coefficients need to be revised.
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Affiliation(s)
- Rob Norris
- University of Pittsburgh School of Medicine, PA, USA
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Abstract
BACKGROUND Trauma is a major cause of mortality and morbidity worldwide. Methods of assessing outcome have evolved with management of trauma victims. RESULTS AND DISCUSSION The wide variety of scoring instruments available to assess the injured patient may be divided into three groups: anatomical, physiological and combined systems. Anatomical systems depend on an accurate description of the injuries sustained. Physiological systems measure the effects of injury on the patient's physiological reserves. Combined systems contain elements of both anatomical and physiological scores. Prospectively, scoring systems help in description, triage, treatment decisions and estimating outcome. Retrospective scoring is helpful in audit, in quality control, in comparing treatment methods or centres, and in identifying unexpected outcomes. Limitations may be inherent in the system or may reflect inaccurate or incomplete data collection.
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Affiliation(s)
- R Kingston
- Department of Orthopaedic Surgery, Adelaide and Meath Hospital, Tallaght, Dublin
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Turégano F, Ots J, Martín J, Bordons E, Perea J, Vega D, López J, López S, Garrido G. Mortalidad hospitalaria en pacientes con traumatismos graves: análisis de la mortalidad evitable. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71835-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Piccinelli M, Patterson M, Braithwaite I, Boot D, Wilkinson G. Anxiety and depression disorders 5 years after severe injuries: a prospective follow-up study. J Psychosom Res 1999; 46:455-64. [PMID: 10404480 DOI: 10.1016/s0022-3999(98)00126-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Individuals with severe injuries were investigated 5 years after the traumatic events, and predictors of anxiety and depression disorders were identified. Trauma victims were selected who had an Injury Severity Score of > or = 16 and were brought to all hospitals in the Mersey region and North Wales over 1 year. The 212 patients aged > or = 15 years who left the hospital alive and lived within an accessible distance of the study hospital in Warrington were contacted 5 years later and 158 (74.5%) received follow-up assessment. Thirty-eight subjects (36.9%) reported "definite" anxiety and/or depression disorders and, of these, only 21.1% reported taking psychotropic medications. Factors associated with anxiety and/or depression disorders at follow-up were: sequelae of head injury (i.e., cognitive problems, posttraumatic seizures, facial pain): writing impairment: disability due to thorax problems; and a new trauma during follow-up. Initial severity or types of injuries and overall residual disability rated by the investigator were not strong predictors of anxiety and/or depression disorders at follow-up.
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Affiliation(s)
- M Piccinelli
- Servizio di Psicologia Medica, Universitá di Verona, Italy
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