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Whitaker J, Edem I, Amoah AS, Dube A, D'Ambruoso L, Rickard RF, Leather AJM, Davies J. Understanding the health system utilisation and reasons for avoidable mortality after fatal injury within a Three-Delays framework in Karonga, Northern Malawi: a retrospective analysis of verbal autopsy data. BMJ Open 2024; 14:e081652. [PMID: 38684258 PMCID: PMC11086451 DOI: 10.1136/bmjopen-2023-081652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES To use verbal autopsy (VA) data to understand health system utilisation and the potential avoidability associated with fatal injury. Then to categorise any evident barriers driving avoidable delays to care within a Three-Delays framework that considers delays to seeking (Delay 1), reaching (Delay 2) or receiving (Delay 3) quality injury care. DESIGN Retrospective analysis of existing VA data routinely collected by a demographic surveillance site. SETTING Karonga Health and Demographic Surveillance Site (HDSS) population, Northern Malawi. PARTICIPANTS Fatally injured members of the HDSS. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the proportion of fatal injury deaths that were potentially avoidable. Secondary outcomes were the delay stage and corresponding barriers associated with avoidable deaths and the health system utilisation for fatal injuries within the health system. RESULTS Of the 252 deaths due to external causes, 185 injury-related deaths were analysed. Deaths were predominantly among young males (median age 30, IQR 11-48), 71.9% (133/185). 35.1% (65/185) were assessed as potentially avoidable. Delay 1 was implicated in 30.8% (20/65) of potentially avoidable deaths, Delay 2 in 61.5% (40/65) and Delay 3 in 75.4% (49/65). Within Delay 1, 'healthcare literacy' was most commonly implicated barrier in 75% (15/20). Within Delay 2, 'communication' and 'prehospital care' were the most commonly implicated in 92.5% (37/40). Within Delay 3, 'physical resources' were most commonly implicated, 85.7% (42/49). CONCLUSIONS VA is feasible for studying pathways to care and health system responsiveness in avoidable deaths following injury and ascertaining the delays that contribute to deaths. A large proportion of injury deaths were avoidable, and we have identified several barriers as potential targets for intervention. Refining and integrating VA with other health system assessment methods is likely necessary to holistically understand an injury care health system.
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Affiliation(s)
- John Whitaker
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Idara Edem
- Insight Institute of Neurosurgery & Neuroscience, Flint, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
| | - Abena S Amoah
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
- Malawi Epidemiological and Intervention Research Unit, Chilumba, Malawi
| | - Albert Dube
- Malawi Epidemiological and Intervention Research Unit, Chilumba, Malawi
| | - Lucia D'Ambruoso
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Surgery, Stellenbosch University, Stellenbosch, South Africa
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Public Health, National Health Service (NHS) Grampian, Grampian, Scotland
| | - Rory F Rickard
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - Andy J M Leather
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Justine Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Surgery, Stellenbosch University, Stellenbosch, South Africa
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Albaaj H, Attergrim J, Strömmer L, Brattström O, Jacobsson M, Wihlke G, Västerbo L, Joneborg E, Gerdin Wärnberg M. Patient and process factors associated with opportunities for improvement in trauma care: a registry-based study. Scand J Trauma Resusc Emerg Med 2023; 31:87. [PMID: 38012791 PMCID: PMC10680227 DOI: 10.1186/s13049-023-01157-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Trauma is one of the leading causes of morbidity and mortality worldwide. Morbidity and mortality review of selected patient cases is used to improve the quality of trauma care by identifying opportunities for improvement (OFI). The aim of this study was to assess how patient and process factors are associated with OFI in trauma care. METHODS We conducted a registry-based study using all patients between 2017 and 2021 from the Karolinska University Hospital who had been reviewed regarding the presence of OFI as defined by a morbidity and mortality conference. We used bi- and multivariable logistic regression to assess the associations between the following patient and process factors and OFI: age, sex, respiratory rate, systolic blood pressure, Glasgow Coma Scale (GCS), Injury Severity Score (ISS), survival at 30 days, highest hospital care level, arrival on working hours, arrival on weekends, intubation status and time to first computed tomography (CT). RESULTS OFI was identified in 300 (5.8%) out of 5182 patients. Age, missing Glasgow Coma Scale, time to first CT, highest hospital care level and ISS were statistically significantly associated with OFI. CONCLUSION Several patient and process factors were found to be associated with OFI, indicating that patients with moderate to severe trauma and those with delays to first CT are at the highest odds of OFI.
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Affiliation(s)
- Hussein Albaaj
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.
| | - Jonatan Attergrim
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
| | - Lovisa Strömmer
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Olof Brattström
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Martin Jacobsson
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, Sweden
| | - Gunilla Wihlke
- Trauma and Reparative Medicine, Karolinska University Hospital, Solna, Sweden
| | - Liselott Västerbo
- Trauma and Reparative Medicine, Karolinska University Hospital, Solna, Sweden
| | - Elias Joneborg
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, Sweden
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Kwon J, Lee M, Kim Y, Moon J, Huh Y, Song S, Kim S, Ko JI, Jung K. Trauma system establishment and outcome improvement: a retrospective national cohort study in South Korea. Int J Surg 2023; 109:2293-2302. [PMID: 37204433 PMCID: PMC10442102 DOI: 10.1097/js9.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/08/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Trauma is a major cause of mortality, disability, and health care costs worldwide. The establishment of a trauma system is known to solve these problems, but few studies have objectively evaluated the impact of a trauma system on outcomes. Since 2012, South Korea has established a national trauma system based on the implementation of 17 regional trauma centers nationwide and the improvement of the prehospital transfer system. This study aimed to measure the changes in performance and outcome according to the established national trauma system. MATERIAL AND METHODS In this national cohort-based, retrospective follow-up observational study, the authors calculated the preventable trauma death rate (PTDR) by conducting a multipanel review of patients who died in 2015, 2017, and 2019. Furthermore, the authors constructed a risk-adjusted mortality prediction model of 4 767 876 patients between 2015 and 2019 using the extended-International Classification of Disease Injury Severity Scores to compare outcomes. RESULTS The PTDR was lower in 2019 than in 2015 (15.7 vs. 30.5, P <0.001) and 2017 (15.7 vs. 19.9%, P <0.001) representing 1247 additional lives saved in 2019 compared to that in 2015. In the risk-adjusted model, total trauma mortality was highest in 2015 at 0.56%, followed by that in 2016 and 2017 (0.50%), 2018 (0.51%), and 2019 (0.48%), revealing a significant decrease in mortality over the years ( P <0.001 for trend), representing nearly 800 additional lives saved. The number of deaths for more severe patients with a probability of survival less than 0.25 significantly decreased from 81.50% in 2015 to 66.17% in 2019 ( P <0.001). CONCLUSIONS The authors observed a significant reduction in the PTDR and risk-adjusted trauma mortality in the 5-year follow-up since 2015 when the national trauma system was established. These findings could serve as a model for low-income and middle-income countries, where trauma systems are not yet established.
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Affiliation(s)
- Junsik Kwon
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
| | - Myeonggyun Lee
- Division of Biostatistics, Department of Population Health, New York University Grossman School of Medicine, New York, USA
| | - Yoon Kim
- Department of Health Policy and Management, Seoul National University College of Medicine
| | - Jonghwan Moon
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
| | - Yo Huh
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
| | - Seoyoung Song
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
| | - Sora Kim
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
| | - Jung-in Ko
- Department of Emergency Medicine
- National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Kyoungwon Jung
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine
- Ajou University Hospital, Gyeonggi South Regional Trauma Center, Suwon
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Designing and conducting initial application of a performance assessment model for in-hospital trauma care. BMC Health Serv Res 2022; 22:273. [PMID: 35232439 PMCID: PMC8887084 DOI: 10.1186/s12913-022-07578-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/01/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Trauma is a major cause of death worldwide, especially in Low and Middle-Income Countries (LMIC). The increase in health care costs and the differences in the quality of provided services indicates the need for trauma care evaluation. This study was done to develop and use a performance assessment model for in-hospital trauma care focusing on traffic injures. METHODS This multi-method study was conducted in three main phases of determining indicators, model development, and model application. Trauma care performance indicators were extracted through literature review and confirmed using a two-round Delphi survey and experts' perspectives. Two focus group discussions and 16 semi-structured interviews were conducted to design the prototype. In the next step, components and the final form of the model were confirmed following pre-determined factors, including importance and necessity, simplicity, clarity, and relevance. Finally, the model was tested by applying it in a trauma center. RESULTS A total of 50 trauma care indicators were approved after reviewing the literature and obtaining the experts' views. The final model consisted of six components of assessment level, teams, methods, scheduling, frequency, and data source. The model application revealed problems of a selected trauma center in terms of information recording, patient deposition, some clinical services, waiting time for deposit, recording medical errors and complications, patient follow-up, and patient satisfaction. CONCLUSION Performance assessment with an appropriate model can identify deficiencies and failures of services provided in trauma centers. Understanding the current situation is one of the main requirements for designing any quality improvement programs.
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Park Y, Lee GJ, Lee MA, Choi KK, Gwak J, Hyun SY, Jeon YB, Yoon YC, Lee J, Yu B. Major Causes of Preventable Death in Trauma Patients. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2020.0074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose Trauma is the top cause of death in people under 45 years of age. Deaths from severe trauma can have a negative economic impact due to the loss of people belonging to socio-economically active age groups. Therefore, efforts to reduce the mortality rate of trauma patients are essential. The purpose of this study was to investigate preventable mortality in trauma patients and to identify factors and healthcare-related challenges affecting mortality. Ultimately, these findings will help to improve the quality of trauma care. Methods We analyzed the deaths of 411 severe trauma patients who presented to Gachon University Gil Hospital regional trauma center in South Korea from January 2015 to December 2017, using an expert panel review. Results The preventable death rate of trauma patients treated at the Gachon University Gil Hospital regional trauma center was 8.0%. Of these, definitely preventable deaths comprised 0.5% and potentially preventable deaths 7.5%. The leading cause of death in trauma patients was traumatic brain injury. Treatment errors most commonly occurred in the intensive care unit (ICU). The most frequent management error was delayed treatment of bleeding. Conclusions Most errors in the treatment of trauma patients occurred in early stages of the treatment process and in the ICU. By identifying the main causes of preventable death and errors during the course of treatment, our research will help to reduce the preventable death rate. Appropriate trauma care systems and ongoing education are also needed to reduce preventable deaths from trauma.
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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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Whitaker J, O'Donohoe N, Denning M, Poenaru D, Guadagno E, Leather AJM, Davies JI. Assessing trauma care systems in low-income and middle-income countries: a systematic review and evidence synthesis mapping the Three Delays framework to injury health system assessments. BMJ Glob Health 2021; 6:e004324. [PMID: 33975885 PMCID: PMC8118008 DOI: 10.1136/bmjgh-2020-004324] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/07/2021] [Accepted: 02/04/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The large burden of injuries falls disproportionately on low/middle-income countries (LMICs). Health system interventions improve outcomes in high-income countries. Assessing LMIC trauma systems supports their improvement. Evaluating systems using a Three Delays framework, considering barriers to seeking (Delay 1), reaching (Delay 2) and receiving care (Delay 3), has aided maternal health gains. Rapid assessments allow timely appraisal within resource and logistically constrained settings. We systematically reviewed existing literature on the assessment of LMIC trauma systems, applying the Three Delays framework and rapid assessment principles. METHODS We conducted a systematic review and narrative synthesis of articles assessing LMIC trauma systems. We searched seven databases and grey literature for studies and reports published until October 2018. Inclusion criteria were an injury care focus and assessment of at least one defined system aspect. We mapped each study to the Three Delays framework and judged its suitability for rapid assessment. RESULTS Of 14 677 articles identified, 111 studies and 8 documents were included. Sub-Saharan Africa was the most commonly included region (44.1%). Delay 3, either alone or in combination, was most commonly assessed (79.3%) followed by Delay 2 (46.8%) and Delay 1 (10.8%). Facility assessment was the most common method of assessment (36.0%). Only 2.7% of studies assessed all Three Delays. We judged 62.6% of study methodologies potentially suitable for rapid assessment. CONCLUSIONS Whole health system injury research is needed as facility capacity assessments dominate. Future studies should consider novel or combined methods to study Delays 1 and 2, alongside care processes and outcomes.
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Affiliation(s)
- John Whitaker
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | | | - Max Denning
- Department of Surgery and Cancer, Imperial College London, London, UK
- Stanford Graduate School of Business, Stanford University, Stanford, California, USA
| | - Dan Poenaru
- Harvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Andrew J M Leather
- King's Centre for Global Health and Health Partnerships, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, UK
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Zhang GX, Chen KJ, Zhu HT, Lin AL, Liu ZH, Liu LC, Ji R, Chan FSY, Fan JKM. Preventable Deaths in Multiple Trauma Patients: The Importance of Auditing and Continuous Quality Improvement. World J Surg 2021; 44:1835-1843. [PMID: 32052106 DOI: 10.1007/s00268-020-05423-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Management errors during pre-hospital care, triage process and resuscitation have been widely reported as the major source of preventable and potentially preventable deaths in multiple trauma patients. Common tools for defining whether it is a preventable, potentially preventable or non-preventable death include the Advanced Trauma Life Support (ATLS®) clinical guideline, the Injury Severity Score (ISS) and the Trauma and Injury Severity Score (TRISS). Therefore, these surrogated scores were utilized in reviewing the study's trauma services. METHODS Trauma data were prospectively collected and retrospectively reviewed from January 1, 2018, to December 31, 2018. All cases of trauma death were discussed and audited by the Hospital Trauma Committee on a regular basis. Standardized form was used to document the patient's management flow and details in every case during the meeting, and the final verdict (whether death was preventable or not) was agreed and signed by every member of the team. The reasons for the death of the patients were further classified into severe injuries, inappropriate/delayed examination, inappropriate/delayed treatment, wrong decision, insufficient supervision/guidance or lack of appropriate guidance. RESULTS A total of 1913 trauma patients were admitted during the study period, 82 of whom were identified as major trauma (either ISS > 15 or trauma team was activated). Among the 82 patients with major trauma, eight were trauma-related deaths, one of which was considered a preventable death and the other 7 were considered unpreventable. The decision from the hospital's performance improvement and patient safety program indicates that for every trauma patient, basic life support principles must be followed in the course of primary investigations for bedside trauma series X-ray (chest and pelvis) and FAST scan in the resuscitation room by a person who meets the criteria for trauma team activation recommended by ATLS®. CONCLUSION Mechanisms to rectify errors in the management of multiple trauma patients are essential for improving the quality of trauma care. Regular auditing in the trauma service is one of the most important parts of performance improvement and patient safety program, and it should be well established by every major trauma center in Mainland China. It can enhance the trauma management processes, decision-making skills and practical skills, thereby continuously improving quality and reducing mortality of this group of patients.
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Affiliation(s)
- Gui-Xi Zhang
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ke-Jin Chen
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Hong-Tao Zhu
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ai-Ling Lin
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zhong-Hui Liu
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Li-Chang Liu
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Ren Ji
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Fion Siu Yin Chan
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam Road, Hong Kong Special Administrative Region, China
| | - Joe King Man Fan
- Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China. .,Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam Road, Hong Kong Special Administrative Region, China.
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Konadu-Yeboah D, Kwasi K, Donkor P, Gudugbe S, Sampen O, Okleme A, Boakye FN, Osei-Ampofo M, Okrah H, Mock C. Preventable Trauma Deaths and Corrective Actions to Prevent Them: A 10-Year Comparative Study at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. World J Surg 2020; 44:3643-3650. [PMID: 32661695 PMCID: PMC7529993 DOI: 10.1007/s00268-020-05683-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the rate of preventable trauma deaths in an African hospital, identify the potential effect of improvements in trauma care over the past decade and identify deficiencies in care that still need to be addressed. METHODS A multidisciplinary panel assessed pre-hospital, hospital, and postmortem data on 89 consecutive in-hospital trauma deaths over 5 months in 2017 at the Komfo Anokye Teaching Hospital. The panel judged the preventability of each death. For definitely and potentially preventable deaths, the panel identified deficiencies in care. RESULTS Thirteen percent (13%) of trauma deaths were definitely preventable, 47% potentially preventable, and 39% non-preventable. In comparison with a panel review in 2007, there was no change in total preventable deaths, but there had been a modest decrease in definitely preventable deaths (25% in 2007 to 13% in 2017, p = 0.07) There was a notable change in the pattern of deficiency (p = 0.001) with decreases in pre-hospital delay (19% of all trauma deaths in 2007 to 3% in 2017) and inadequate resuscitation (17 to 8%), but an increase in delay in treatment at the hospital (23 to 40%). CONCLUSIONS Over the past decade, there have been improvements in pre-hospital transport and in-hospital resuscitation. However, the preventable death rate remains unacceptably high and there are still deficiencies to address. This study also demonstrates that preventable death panel reviews are a feasible method of trauma quality improvement in the low- and middle-income country setting.
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Affiliation(s)
- Dominic Konadu-Yeboah
- Directorate of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kusi Kwasi
- Directorate of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Senyo Gudugbe
- Directorate of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ossei Sampen
- Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Augustus Okleme
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Maxwell Osei-Ampofo
- Directorate of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Helena Okrah
- Department of Anaesthesia, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA.
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Assessing barriers to quality trauma care in low and middle-income countries: A Delphi study. Injury 2020; 51:278-285. [PMID: 31883865 DOI: 10.1016/j.injury.2019.12.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Most deaths from injury occur in Low and Middle Income Countries (LMICs) with one third potentially avoidable with better health system access. This study aimed to establish consensus on the most important barriers, within a Three Delays framework, to accessing injury care in LMICs that should be considered when evaluating a health system. METHODS A three round electronic Delphi study was conducted with experts in LMIC health systems or injury care. In round one, participants proposed important barriers. These were synthesized into a three delays framework. In round 2 participants scored four components for each barrier. Components measured whether barriers were feasible to assess, likely to delay care for a significant proportion of injured persons, likely to cause avoidable death or disability, and potentially readily changed to improve care. In round 3 participants re-scored each barrier following review of feedback from round 2. Consensus was defined for each component as ≥70% agreement or disagreement. RESULTS There were 37 eligible responses in round 1, 30 in round 2, and 27 in round 3, with 21 countries represented in all rounds. Of the twenty conceptual barriers identified, consensus was reached on all four components for 11 barriers. This included 2 barriers to seeking care, 5 barriers to reaching care and 4 barriers to receiving care. The ability to modify a barrier most frequently failed to achieve consensus. CONCLUSION 11 barriers were agreed to be feasible to assess, delay care for many, cause avoidable death or disability, and be readily modifiable. We recommend these barriers are considered in assessments of LMIC trauma systems.
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Pfeifer R, Halvachizadeh S, Schick S, Sprengel K, Jensen KO, Teuben M, Mica L, Neuhaus V, Pape HC. Are Pre-hospital Trauma Deaths Preventable? A Systematic Literature Review. World J Surg 2019; 43:2438-2446. [PMID: 31214829 DOI: 10.1007/s00268-019-05056-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The first and largest peak of trauma mortality is encountered on the trauma site. The aim of this study was to determine whether these trauma-related deaths are preventable. We performed a systematic literature review with a focus on pre-hospital preventable deaths in severely injured patients and their causes. METHODS Studies published in a peer-reviewed journal between January 1, 1990 and January 10, 2018 were included. Parameters of interest: country of publication, number of patients included, preventable death rate (PP = potentially preventable and DP = definitely preventable), inclusion criteria within studies (pre-hospital only, pre-hospital and hospital deaths), definition of preventability used in each study, type of trauma (blunt versus penetrating), study design (prospective versus retrospective) and causes for preventability mentioned within the study. RESULTS After a systematic literature search, 19 papers (total 7235 death) were included in this literature review. The majority (63.1%) of studies used autopsies combined with an expert panel to assess the preventability of death in the patients. Pre-hospital death rates range from 14.6 to 47.6%, in which 4.9-11.3% were definitely preventable and 25.8-42.7% were potentially preventable. The most common (27-58%) reason was a delayed treatment of the trauma victims, followed by management (40-60%) and treatment errors (50-76.6%). CONCLUSION According to our systematic review, a relevant amount of the observed mortality was described as preventable due to delays in treatment and management/treatment errors. Standards in the pre-hospital trauma system and management should be discussed in order to find strategies to reduce mortality.
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Affiliation(s)
- Roman Pfeifer
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| | - Sascha Halvachizadeh
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Sylvia Schick
- Institute of Legal Medicine, Ludwig-Maximillians-Universität (LMU) Munich, Munich, Germany
| | - Kai Sprengel
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Kai Oliver Jensen
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Michel Teuben
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Ladislav Mica
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Valentin Neuhaus
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
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Edem IJ, Dare AJ, Byass P, D'Ambruoso L, Kahn K, Leather AJM, Tollman S, Whitaker J, Davies J. External injuries, trauma and avoidable deaths in Agincourt, South Africa: a retrospective observational and qualitative study. BMJ Open 2019; 9:e027576. [PMID: 31167869 PMCID: PMC6561452 DOI: 10.1136/bmjopen-2018-027576] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Injury burden is highest in low-income and middle-income countries. To reduce avoidable deaths, it is necessary to identify health system deficiencies preventing timely, quality care. We developed criteria to use verbal autopsy (VA) data to identify avoidable deaths and associated health system deficiencies. SETTING Agincourt, a rural Bushbuckridge municipality, Mpumalanga Province, South Africa. PARTICIPANTS Agincourt Health and Socio-Demographic Surveillance System and healthcare providers (HCPs) from local hospitals. METHODS A literature review to explore definitions of avoidable deaths after trauma and barriers to access to care using the 'three delays framework' (seeking, reaching and receiving care) was performed. Based on these definitions, this study developed criteria, applicable for use with VA data, for identifying avoidable death and which of the three delays contributed to avoidable deaths. These criteria were then applied retrospectively to the VA-defined category external injury deaths (EIDs-a subset of which are trauma deaths) from 2012 to 2015. The findings were validated by external expert review. Key informant interviews (KIIs) with HCPs were performed to further explore delays to care. RESULTS Using VA data, avoidable death was defined with a focus on survivability, using level of consciousness at the scene and ability to seek care as indicators. Of 260 EIDs (189 trauma deaths), there were 104 (40%) avoidable EIDs and 78 (30%) avoidable trauma deaths (41% of trauma deaths). Delay in receiving care was the largest contributor to avoidable EIDs (61%) and trauma deaths (59%), followed by delay in seeking care (24% and 23%) and in reaching care (15% and 18%). KIIs revealed context-specific factors contributing to the third delay, including difficult referral systems. CONCLUSIONS A substantial proportion of EIDs and trauma deaths were avoidable, mainly occurring due to facility-based delays in care. Interventions, including strengthening referral networks, may substantially reduce trauma deaths.
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Affiliation(s)
- Idara J Edem
- Department of Surgery, Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Anna J Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter Byass
- Umeå Centre for Global Health Research, Umea Universitet, Umeå, Sweden
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Lucia D'Ambruoso
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Centre for Global Development and Institute of Applied Health Sciences, University of Aberdeen School of Medicine and Dentistry, Aberdeen, UK
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Andy J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - John Whitaker
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Justine Davies
- Centre for Applied Health Research, University of Birmingham, Birmingham, UK
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Janati A, Mousazadeh Y, Sadeghi-Bazargani H, Pouraghaei M, Rahmani F. Prediction of mortality risk in patients with traffic injury: A case study in tabriz hospitals, Iran. ARCHIVES OF TRAUMA RESEARCH 2019. [DOI: 10.4103/atr.atr_5_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ameri M, Aghakhani K, Memarian A, Ameri E. Epidemiology of sport trauma: a prospective study. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2018. [DOI: 10.23736/s0393-3660.18.03685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Khazaei S, Rezaeian S, Mazharmanesh S, Ahmadi-Pishkuhi M, Baigi V, Khazaei Z, Veisani Y. Epidemiologic Aspects of Overall Injuries in Hamadan Province; A Six-Year Registry-Based Analysis. Bull Emerg Trauma 2018; 6:233-238. [PMID: 30090819 PMCID: PMC6078468 DOI: 10.29252/beat-060308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: To investigate the epidemiological aspects of all-cause injuries in Hamadan province during a 6-year period. Methods: We conducted a cross-sectional study on injured subjects admitted to private or governmental hospitals in Hamadan province during March 2009 to March 2015. The epidemiological characteristics were retrieved from a registry-based system including gender, residency, injury mechanism and date of injury occurrence, outcome of hospitalization (full recovery/disability/death). Results: Totally, 135,925 hospitalized injured cases were recorded. The majority of cases were male (72.6%) and were occurred in urban areas (60%), about 40% of patients were in 20-34 years’ age group, and the highest proportion (30.13%) of injuries occurred in summer. Logistic regression showed that the odds of disability vs. recovery was significantly higher in rural areas [Adjusted odds ratio (AOR) =3.42] and the odds of death vs. recovery was higher among male gender (AOR=1.46). In addition, comparing to the 0-4-year age-group, odds of death were significantly higher in middle aged and elderly victims. Conclusion: Our findings showed that middle age groups, male gender and urban area increase the odds of death. Injured males and old age subjects had the highest odds of death and out of residential area injuries were common cause of leading death injuries.
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Affiliation(s)
- Salman Khazaei
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shahab Rezaeian
- Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sakineh Mazharmanesh
- Department of Health Services, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahin Ahmadi-Pishkuhi
- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zaher Khazaei
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Yousef Veisani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, IR Iran
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Ghorbani P, Strömmer L. Analysis of preventable deaths and errors in trauma care in a Scandinavian trauma level-I centre. Acta Anaesthesiol Scand 2018; 62:1146-1153. [PMID: 29797712 DOI: 10.1111/aas.13151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/29/2018] [Accepted: 04/15/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The wide disparity in the methodology of preventable death analysis has created a lack of comparability among previous studies. The guidelines for the peer review (PR) procedure suggest the inclusion of risk-adjustment methods to identify patients to review, that is, exclude non-preventable deaths (probability of survival [Ps] < 25%) or focus on preventable deaths (Ps > 50%). We aimed to, through PR process, (1) identify preventable death and errors committed in a level-I trauma centre, and (2) explore the use of different risk-adjustment methods as a complement. METHODS A multidisciplinary committee reviewed all trauma patients, which died a trauma-related death, within 30 days of admission to Karolinska University Hospital, Stockholm, in the period of 2012-2016. Ps was calculated according to TRISS and NORMIT and their accuracy where compared. RESULTS Two hundred and ninety-eight deaths were identified and 252 were reviewed. The majority of deaths occurred between 1 and 7 days. Ten deaths (4.0%) were classified as preventable. Sixty-seven errors were identified in 53 (21.0%) deaths. The most common error was inappropriate treatment in all deaths (21 of 67) and in preventable deaths (5 of 13). Median Ps in non-preventable deaths was higher than the cut-off (<25%) and Ps-TRISS was almost twice as high as Ps-NORMIT (65% vs 33%, P < .001). Two clinically judged preventable deaths with Ps <25% would have been missed with both models. Median Ps in preventable deaths was above the cut-off (>50%) and higher with Ps-TRISS vs Ps-NORMIT (75% vs 58%, P < .001). Three and 4 clinically judged preventable deaths would have been missed, respectively, for TRISS and NORMIT, if using this cut-off. CONCLUSION Preventable deaths were commonly caused by clinical judgment errors in the early phases but death occurred late. Ps calculated with NORMIT was more accurate than TRISS in predicting mortality, but both perform poorly in identifying preventable and non-preventable deaths when applying the cut-offs. PR of all trauma death is still the golden standard in preventability analysis.
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Affiliation(s)
- P Ghorbani
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
| | - L Strömmer
- Division of Surgery, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden
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Zuraik C, Sampalis J. Epidemiology of Traumatic Injuries at an Urban Hospital in Port-au-Prince, Haiti. World J Surg 2018; 41:2674-2680. [PMID: 28681141 DOI: 10.1007/s00268-017-4088-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Traumatic injuries represent a major burden of disease worldwide. Haiti lacks statistics on the epidemiology of traumatic injuries, as there is no formal injury surveillance program. This study will assess the burden of traumatic injuries in an urban trauma center in the capital city of Port-au-Prince, Haiti. METHODS A retrospective, cross-sectional chart review study at an urban trauma hospital was carried out for the period December 1, 2015, to January 31, 2016. Data were obtained through the hospital's main patient logbook, medical charts, and trauma registry forms. Data on medical documentation, demographics, and injury characteristics were collected and analyzed using descriptive statistics. RESULTS A total of 410 patients were evaluated for treatment of traumatic injuries during the 2-month study. The mean age in years was 30, with 66.3% male and 78.4% less than 41 years of age. There were 6.6 injuries per day and no correlation between frequency of injury and day of the week. Road traffic accidents accounted for 43.0% of trauma modes. The mean and median length of stay were 6.6 and 3.0 days. 9.0% of patients suffered severe trauma (ISS ≥ 16). 21.0% of patients with traumatic brain injury suffered severe head injuries. Extremity trauma was the most frequently injured anatomical region (50.0%). 22.7% of patients were admitted, and 15.1% patients underwent at least one surgical procedure. CONCLUSIONS Road traffic accidents are the primary reason for injury; thus, prevention initiatives and improved trauma care may provide substantial public health benefits.
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Affiliation(s)
- Christopher Zuraik
- Department of Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Canada.,Scientific Affairs, JSS Medical Research Inc., 9400 Henri-Bourassa Blvd. West, St Laurent, QC, H4S1N8, Canada
| | - John Sampalis
- Department of Experimental Surgery, Faculty of Medicine, McGill University, Montreal, Canada. .,Scientific Affairs, JSS Medical Research Inc., 9400 Henri-Bourassa Blvd. West, St Laurent, QC, H4S1N8, Canada.
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Abstract
Injuries cause about 10% of all deaths worldwide, with road traffic accidents, self-inflicted injuries, violence and war injuries being the most common causes of traumatic deaths. There is an anticipated increase in all of these categories by the year 2020. In addition to the increasing global incidence of trauma, other major trends in trauma and its management identified in this review include the growing emphasis on prevention and public health aspects of trauma, the globalization of trauma practices due to the rapid access to new information, a critical emphasis on organizational aspects of trauma care and education, the prominent role of efficacious and cost effective management practises, a shift to gentler treatment methods with less interference in the physiological recovery mechanisms, and at the same time, extreme care and the management of its consequences. In order to fight the global epidemic of trauma, it is the duty and the privilege of health care professionals to take the leadership in this task by ‘thinking globally and acting locally’ but most importantly by working together and sharing their expe riences (the successes and the failures) and by knowing that they can make a difference.
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Affiliation(s)
- AK Leppäniemi
- Department of Surgery, Meilahti Hospital, University of Helsinki, Finland,
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Schoeneberg C, Schilling M, Hussmann B, Schmitz D, Lendemans S, Ruchholtz S. Preventable and potentially preventable deaths in severely injured patients: a retrospective analysis including patterns of errors. Eur J Trauma Emerg Surg 2016; 43:481-489. [PMID: 27072108 DOI: 10.1007/s00068-016-0670-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/01/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Analyzing preventable and potentially preventable deaths is a well-known procedure for improving trauma care. This study analyzes preventable and potentially preventable deaths in German trauma patients. METHODS Patients aged between 16 and 75 years with an Injury Severity Score >15 who were primary admitted from July 2002 to December 2011 were analyzed in this study. Data from the patients' hospital records were retrospectively analyzed, and cases were categorized as preventable, potentially preventable, and non-preventable deaths. In addition, trauma management was screened for errors. RESULTS 2304 patients were admitted from July 2002 to December 2011. 763 of which fulfilled the defined criteria. The mortality rate was 25.3 %. Eight cases (4.2 %) were declared as preventable deaths and 31 cases (16.1 %) as potentially preventable deaths. The most common errors in preclinical trauma care related to airway management. The main clinical error was insufficient hemorrhage control. Fluid overload from infusion was the second most common fault in both. CONCLUSIONS Preventable and potentially preventable errors still occur in the treatment of severely injured patients. Errors in hemorrhage control and airway management are the most common human treatment errors. The knowledge of these errors could help to improve trauma care in the future.
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Affiliation(s)
- C Schoeneberg
- Department of Emergency and Orthopedic Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany.
| | - M Schilling
- Clinic for Orthopedics, Pius-Hospital Oldenburg, Oldenburg, Germany
| | - B Hussmann
- Department of Emergency and Orthopedic Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany
| | - D Schmitz
- Department of Emergency and Orthopedic Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany
| | - S Lendemans
- Department of Emergency and Orthopedic Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany
| | - S Ruchholtz
- Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg, Marburg, Germany
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Oliver GJ, Walter DP. A Call for Consensus on Methodology and Terminology to Improve Comparability in the Study of Preventable Prehospital Trauma Deaths: A Systematic Literature Review. Acad Emerg Med 2016; 23:503-10. [PMID: 26844807 DOI: 10.1111/acem.12932] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 11/04/2015] [Accepted: 11/09/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The study of preventable deaths is essential to trauma research for measuring service quality and highlighting avenues for improving care and as a performance indicator. However, variations in the terminology and methodology of studies on preventable prehospital trauma death limit the comparability and wider application of data. The objective of this study was to describe the heterogeneity in terminology and methodology. METHODS We performed a systematic literature review and report this using the PRISMA guidelines. Searches were conducted using PubMed (including Medline), Ovid, and Embase databases. Studies, with a full text available in English published between 1990 and 2015, meeting the following inclusion criteria were included: analysis of 1) deaths from trauma, 2) occurring in the prehospital phase of care, and 3) application of criteria to ascertain whether deaths were preventable. One author screened database results for relevance by title and abstract. The full text of identified papers was reviewed for inclusion. The reference list of included papers was screened for studies not identified by the database search. Data were extracted on predefined core elements relating to preventability reporting and definitions using a standardized form. RESULTS Twenty-seven studies meeting the inclusion criteria were identified: 12 studies used two categories to assess the preventability of death while 15 used three categories. Fifteen variations in the terminology of these categories and combination with death descriptors were found. Eleven different approaches were used in defining what constituted a preventable death. Twenty-one included survivability of injuries as a criterion. Methods used to determine survivability differed and eight variations in parameters for categorization of deaths were used. Nineteen used panel review in determining preventability with six implementing panel blinding. Panel composition varied greatly by expertise of personnel. Separation of prehospital deaths differed with 10 separating those dead at scene (DAS) and dead on arrival, three excluding those DAS, three excluding deaths prior to EMS arrival, and 11 not separating prehospital deaths. CONCLUSIONS The heterogeneity in methodology, terminology, and definitions of "preventable" between studies render data incomparable. To facilitate common understanding, comparability, and analysis, a commonly agreed ontology by the prehospital research community is required.
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Affiliation(s)
- Govind J. Oliver
- British Red Cross Research Fellow; London
- Humanitarian and Conflict Response Institute; University of Manchester; Manchester UK
| | - Darren P. Walter
- Humanitarian and Conflict Response Institute; University of Manchester; Manchester UK
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McCullough C, DeGennaro V, Bagley JK, Sharma J, Saint-Fort M, Henrys JH. A national trauma capacity assessment of Haiti. J Surg Res 2016; 201:126-33. [DOI: 10.1016/j.jss.2015.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/01/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
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Gholipour C, Rad BS, Vahdati SS, Ghaffarzad A, Masoud A. Evaluation of preventable trauma death in emergency department of Imam Reza hospital. World J Emerg Med 2016; 7:135-7. [PMID: 27313809 PMCID: PMC4905870 DOI: 10.5847/wjem.j.1920-8642.2016.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/19/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents (MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This study aimed to investigate the causes and prevention of death in trauma patients. METHODS This retrospective, descriptive-analytic study assessed 100 trauma patients referred to our emergency department (ED) from January 2013 to Januanry 2015. The included patients were those with trauma died after arrival at our ED. Age, sex, cause of trauma, clinical causes of death, causes of death defined by autopsy, way of transfer to the ED, time of ambulance arrival at the scene of trauma, and time elapsed to enter the ED from the scene of trauma were studied. RESULTS In the 100 patients, 21 (21%) patients were female and 79 (79%) male. Forty-three patients were older than 60 years. Trauma was largely due to pedestrian accidents in 31% of the patients, and 33% had a hypo-volemic shock. About 80% of deaths were due to intra-cranial hemorrhage (ICH) or intra-ventricular hemorrhage (IVH), and spinal injuries were not preventable. Autopsy revealed that 28% of the patients suffered from internal injuries. Autopsy revealed that 19% of the deaths were not preventable and 81% were considered preventable. In our patients, 76 were transferred to the hospital by emergency medicine services (EMS). Analysis of time for ambulance arrival to the scene and frequency of death revealed that 52.2% of the deaths occurred between 11 and 15 minutes. Analysis of time for admission to the ED from the scene of trauma showed that 74.6% deaths occurred between 6 and 10 minutes. CONCLUSIONS The rate of hospital preventable deaths is about 80%, a high mortality rate, which denotes a lack of proper diagnosis and treatment. The time for arrival of EMS at the scene of trauma is longer than that in other countries.
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Affiliation(s)
- Changiz Gholipour
- Road Traffic Injury Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Bahram Samadi Rad
- Legal Medicine Research Center, Legal Medicine Organization. Tehran, Iran
| | - Samad Shams Vahdati
- Road Traffic Injury Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Amir Ghaffarzad
- Emergency Department, Tabriz University of Medical Science, Tabriz, Iran
| | - Armita Masoud
- Emergency Department, Tabriz University of Medical Science, Tabriz, Iran
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Stewart BT, Gyedu A, Quansah R, Addo WL, Afoko A, Agbenorku P, Amponsah-Manu F, Ankomah J, Appiah-Denkyira E, Baffoe P, Debrah S, Donkor P, Dorvlo T, Japiong K, Kushner AL, Morna M, Ofosu A, Oppong-Nketia V, Tabiri S, Mock C. District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries. Injury 2016; 47:211-9. [PMID: 26492882 PMCID: PMC4698059 DOI: 10.1016/j.injury.2015.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/21/2015] [Accepted: 09/12/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly. METHODS Consensus on trauma care audit filters was built between twenty panellists using a Delphi technique with four anonymous, iterative surveys designed to elicit: (i) trauma care processes to be measured; (ii) important features of audit filters for the district-level hospital setting; and (iii) potentially useful filters. Filters were ranked on a scale from 0 to 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8. RESULTS Panellists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1--0.58; Round 2--0.66; Round 3--0.76; and Round 4--0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage--vital signs are recorded within 15 min of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation--a large bore IV was placed within 15 min of patient arrival; referral--if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. CONCLUSION This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs, the collection and reporting of prospective trauma care audit filters may be an important step towards improving care for the injured at district-level hospitals in LMICs.
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Affiliation(s)
- Barclay T Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Adam Gyedu
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Robert Quansah
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wilfred Larbi Addo
- Eastern Regional Health Directorate, Ghana Health Service, Koforidua, Ghana
| | - Akis Afoko
- Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana
| | - Pius Agbenorku
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - James Ankomah
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Peter Baffoe
- Department of Obstetrics and Gynecology, Upper East Regional Hospital, Bolgatanga, Ghana
| | - Sam Debrah
- Department of Surgery, University of Cape Coast, Cape Coast, Ghana
| | - Peter Donkor
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Theodor Dorvlo
- Department of Surgery, Eastern Regional Hospital, Koforidua, Ghana
| | - Kennedy Japiong
- Department of Emergency Medicine, Police Hospital, Accra, Ghana
| | - Adam L Kushner
- Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA
| | - Martin Morna
- Department of Surgery, University of Cape Coast, Cape Coast, Ghana
| | | | | | - Stephen Tabiri
- Department of Surgery, Tamale Teaching Hospital, Tamale, Ghana; Department of Surgery, University of Development Studies, Tamale, Ghana
| | - Charles Mock
- Harborview Injury Prevention & Research Center, Seattle, WA, USA; Department of Surgery, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
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Jalalvandi F, Arasteh P, Safari Faramani R, Esmaeilivand M. Epidemiology of Pediatric Trauma and Its Patterns in Western Iran: A Hospital Based Experience. Glob J Health Sci 2015; 8:139-46. [PMID: 26755468 PMCID: PMC4954915 DOI: 10.5539/gjhs.v8n6p139] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 09/03/2015] [Accepted: 10/26/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND & OBJECTIVE Trauma is a major cause of mortality in children aged 1 to 14 years old and its patterns differs from country to country. In this study we investigated the epidemiology and distribution of non-intentional trauma in the pediatric population. MATERIALS & METHODS The archives of 304 children below 10 years old who presented to Taleghani trauma care center in Kermanshah, Iran from March to September 2008, were reviewed. Patients' demographic and injury related information were registered. The participants were categorized into three age groups of 0-2, 3-6 and 7-10 years old and the data was compared among age groups and between both sexes. FINDINGS The most common cause for trauma was falling from heights (65.5%) and road traffic accidents (16.4%). The most common anatomical sites of injury were the upper limbs followed by the head and neck (36.8% and 31.2%, respectively). Injuries mostly occurred in homes (67.4%). The injuries were mostly related to the orthopedics and the neurosurgery division (84.1% and 13.1%, respectively). Accident rates peaked during the hours of 18-24 (41.3%). Male and female patients did display any difference regarding the variables.Children between the ages of 0-2 years old had the highest rate of injury to the head and neck area (40.3%) (p=0.024). Falls and road traffic accidents displayed increasing rates from the ages of 0-2 to 3-6 and decreasing rates to the ages of 7-10 years old (p=0.013). From the ages of 0-2 to 3-6 years old, street accidents increased and household traumas decreased. After that age household trauma rates increased and street accidents decreased (p=0.005). Children between the ages of 7-10 years old had the highest rate of orthopedic injury (p=0.029). CONCLUSION Special planning and health policies are needed to prevent road accidents especially in children between the ages of 3-6 years old. Since homes were the place where children between the ages of 0-2 were mostly injured, parents should be educated about the correct safety measures that they need to take regarding their children's environments. The orthopedics department needs to receive the most training and resources for the management of pediatric trauma.
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Affiliation(s)
- Fereshteh Jalalvandi
- Faculty member of paramedical school. Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Compliance of district hospitals in the Center Region of Cameroon with WHO/IATSIC guidelines for the care of the injured: a cross-sectional analysis. World J Surg 2015; 38:2525-33. [PMID: 24838483 DOI: 10.1007/s00268-014-2609-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Injuries are a major cause of death and disability worldwide. Low-income countries, particularly in Africa, are disproportionately affected. The burden of injuries can be alleviated by preventive measures and appropriate management of injury cases. African countries generally lack trauma care systems based on reliable and affordable guidelines. The aim of this study was to assess the compliance of some district hospitals in Cameroon with World Health Organization/International Association for Trauma and Intensive Care (WHO/IATSIC) guidelines for care of the injured. METHODS This cross-sectional descriptive survey used items from the WHO/IATSIC "Guidelines for Essential Trauma Care" to develop a checklist for inspection of physical equipment and a questionnaire assessing human resources and organizational capabilities in 25 district hospitals of the Center Region of Cameroon. RESULTS All hospitals surveyed had at least one doctor available. Each reported treating a mean of 338 ± 214 injury cases every year. Most hospitals (n = 22) were globally either not compliant or partly compliant with the guidelines. Staff generally had received the appropriate basic training but had no additional training specifically directed toward trauma management. Skills for managing specific injuries (e.g., chest injuries) were poor. Availability and utilization of equipment was globally inadequate, and organizational capabilities were almost nonexistent. CONCLUSIONS District hospitals of the Center Region of Cameroon still lack compliance with the WHO/IATSIC guidelines for essential trauma care but have significant potential for improvement. It seems possible to optimize the utilization of existing facilities.
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Yeboah D, Mock C, Karikari P, Agyei-Baffour P, Donkor P, Ebel B. Minimizing preventable trauma deaths in a limited-resource setting: a test-case of a multidisciplinary panel review approach at the Komfo Anokye Teaching Hospital in Ghana. World J Surg 2015; 38:1707-12. [PMID: 24449414 DOI: 10.1007/s00268-014-2452-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Our objectives were to determine the proportion of preventable trauma deaths at a large trauma hospital in Kumasi, Ghana, and to identify opportunities for the improvement of trauma care. METHODS A multidisciplinary panel of experts evaluated pre-hospital, hospital, and postmortem data of consecutive trauma patients who died over a 5-month period in 2006-2007 at the Komfo Anokye Teaching Hospital. The panel judged the preventability of each death. For preventable and potentially preventable deaths, deficiencies in care that contributed to their deaths were identified. RESULTS The panel reviewed 231 trauma deaths. Of these, 84 charts had sufficient information to review preventable factors. The panel determined that 23 % of trauma deaths were definitely preventable, 37 % were potentially preventable, and 40 % were not preventable. One main deficiency in care was identified for each of the 50 definitely preventable and potentially preventable deaths. The most common deficiencies were pre-hospital delays (44 % of the 50 deficiencies), delay in treatment (32 %), and inadequate fluid resuscitation (22 %). Among the 19 definitely preventable deaths, the most common cause of death was hemorrhage (47 %), and the most common deficiencies were inadequate fluid resuscitation (37 % of deficiencies in this group) and pre-hospital delay (37 %). CONCLUSIONS A high proportion of trauma fatalities might have been preventable by decreasing pre-hospital delays, adequate resuscitation in hospital, and earlier initiation of care, including definitive surgical management. The study also showed that preventable death panel reviews are a feasible and useful quality improvement method in the study setting.
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Affiliation(s)
- Dominic Yeboah
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana,
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27
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Schoeneberg C, Schilling M, Probst T, Lendemans S. Preventable and potentially preventable deaths in severely injured elderly patients: a single-center retrospective data analysis of a German trauma center. World J Surg 2015; 38:3125-32. [PMID: 25167897 DOI: 10.1007/s00268-014-2755-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to widespread demographic changes, populations in industrial countries are ageing. A common tool for quality improvement of trauma care is the analysis of deaths in trauma patients. This study focuses on preventable or potentially preventable deaths, and on patterns of errors in severely injured elderly patients, a group that is under-represented in the literature. METHODS Data from a level 1 trauma center in Germany were analyzed for this study. A retrospective chart analysis was performed for all deceased patients older than 75 years with an Injury Severity Score greater than 15. Additionally, the data from the Trauma Registry of the German Society for Trauma Surgery were used. According to a Trauma Division Morbidity and Mortality conference, and after a review of all authors, deaths were classified as preventable, potentially preventable, and non-preventable. RESULTS Of the 2,304 patients admitted to the trauma room, 108 met the inclusion criteria. A total of 62 (57.41 %) patients died. Two deaths were declared as preventable deaths (3.23 %) and eight as potentially preventable (12.90 %). The most common preclinical error was associated with airway management. Hemorrhage control was the leading error in the clinical setting. Excessive fluid volume resuscitation was the second most common error detected. CONCLUSION The rate of preventable or potentially preventable deaths in severely injured elderly patients is similar to that reported for other age groups. Thus, most errors were human judgment errors or human treatment errors; therefore, education and training in the treatment of severely injured patients is extremely important.
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Affiliation(s)
- Carsten Schoeneberg
- Department of Trauma Surgery, University Hospital Essen, University Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany,
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Sarhangi F, Gholami HR, Khaghanizade M, Najafi Mehri S. First Aid and Transportation Course Contents Based on Experience gained in the Iran-Iraq War: a Qualitative Study. Trauma Mon 2015; 20:e23846. [PMID: 25825700 PMCID: PMC4362035 DOI: 10.5812/traumamon.23846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 01/10/2015] [Accepted: 01/17/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Effective first aid and transportation influences injury-induced mortality. But few qualitative studies have been conducted so far in this area. OBJECTIVES The aim of this study was to identify the content of the first aid and patient transportation course based on experience gained from the Iran-Iraq war. PATIENTS AND METHODS This was a conventional qualitative content analysis study; a purposeful sample of 14 first aid and transportation experts who had worked during the Iran-Iraq war was recruited. We collected and analyzed the study data by using the semi-structured interview method and the conventional content analysis approach respectively. Each interview transcript was reviewed several times. Words, sentences, and paragraphs were labeled with codes. Codes were compared with each other and categorized according to their similarities. Similar sub-categories and categories were also grouped together and formed themes. RESULTS Study participants' experiences of wartime first aid and transportation (FAT) education fell into two main themes including 'the congruence of education and educational needs' and 'managers' engagement in FAT education. The four main categories of these two themes were use of appropriate educational facilities, adopting effective teaching strategies, universal FAT education and specialized training skills. CONCLUSIONS The two key requirements of the first aid and transportation courses are practicality and managerial engagement. We developed and provided specific guidance of FAT curriculum by using the study findings. This curriculum is recommended for educating FAT staffs, paramedics, emergency technicians, and military nurses.
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Affiliation(s)
- Forogh Sarhangi
- Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hamid Reza Gholami
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Hamid Reza Gholami, Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. Tel: +98-212126127278, Fax: +98-2122289941, E-mail:
| | - Morteza Khaghanizade
- Behavioral Sciences Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Soheil Najafi Mehri
- Faculty of Nursing, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
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Abstract
There is a high rate of mortality in elderly
patients who sustain a fracture of the hip. We aimed to determine
the rate of preventable mortality and errors during the management
of these patients. A 12 month prospective study was performed on
patients aged > 65 years who had sustained a fracture of the hip.
This was conducted at a Level 1 Trauma Centre with no orthogeriatric
service. A multidisciplinary review of the medical records by four
specialists was performed to analyse errors of management and elements
of preventable mortality. During 2011, there were 437 patients aged
> 65 years admitted with a fracture of the hip (85 years (66 to
99)) and 20 died while in hospital (86.3 years (67 to 96)). A total
of 152 errors were identified in the 80 individual reviews of the
20 deaths. A total of 99 errors (65%) were thought to have at least
a moderate effect on death; 45 reviews considering death (57%) were thought
to have potentially been preventable. Agreement between the panel
of reviewers on the preventability of death was fair. A larger-scale
assessment of preventable mortality in elderly patients who sustain
a fracture of the hip is required. Multidisciplinary review panels
could be considered as part of the quality assurance process in
the management of these patients. Cite this article: Bone Joint J 2014;96-B:1178–84.
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Affiliation(s)
- S M Tarrant
- John Hunter Hospital, Newcastle, University of Newcastle, Department of Traumatology, John Hunter Hospital and University of Newcastle, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia
| | - B M Hardy
- John Hunter Hospital, Newcastle, University of Newcastle, Department of Traumatology, John Hunter Hospital and University of Newcastle, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia
| | - P L Byth
- John Hunter Hospital, Newcastle, University of Newcastle, Department of Traumatology, John Hunter Hospital and University of Newcastle, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia
| | - T L Brown
- John Hunter Hospital, Newcastle, University of Newcastle, Department of Traumatology, John Hunter Hospital and University of Newcastle, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia
| | - J Attia
- John Hunter Hospital, Newcastle, University of Newcastle, Department of Traumatology, John Hunter Hospital and University of Newcastle, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia
| | - Z J Balogh
- John Hunter Hospital, Newcastle, University of Newcastle, Department of Traumatology, John Hunter Hospital and University of Newcastle, Locked Bag 1, Hunter Region Mail Centre, Newcastle, NSW, 2310, Australia
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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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Norouzpour A, Khoshdel AR, Modaghegh MH, Kazemzadeh GH. Prehospital management of gunshot patients at major trauma care centers: exploring the gaps in patient care. Trauma Mon 2013; 18:62-6. [PMID: 24350154 PMCID: PMC3860682 DOI: 10.5812/traumamon.10438] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/13/2013] [Accepted: 04/25/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Prehospital management of gunshot-wounded (GW) patients influences injury-induced morbidity and mortality. OBJECTIVES To evaluate prehospital management to GW patients emphasizing the protocol of patient transfer to appropriate centers. PATIENTS AND METHODS This prospective study, included all GW patients referred to four major, level-I hospitals in Mashhad, Iran. We evaluated demographic data, triage, transport vehicles of patients, hospitalization time and the outcome. RESULTS There were 66 GW patients. The most affected body parts were extremities (60.6%, n = 40); 59% of cases (n = 39) were transferred to the hospitals with vehicles other than an ambulance. Furthermore, 77.3% of patients came to the hospitals directly from the site of event, and 22.7% of patients were referred from other medical centers. EMS action intervals from dispatchers to scene departure was not significantly different from established standards; however, arrival to hospital took longer than optimal standards. Additionally, time spent at emergency wards to stabilize vital signs was significantly less in patients who were transported by EMS ambulances (P = 0.01), but not with private ambulances (P = 0.47). However, ambulance pre-hospital care was not associated with a shorter hospital stay. Injury Severity was the only determinant of hospital stay duration (β = 0.36, P = 0.01) in multivariate analysis. CONCLUSIONS GW was more frequent in extremities and the most patients were directly transferred from the accident site. EMS (but not private) ambulance transport improved patients' emergency care and standard time intervals were achieved by EMS; however more than a half of the cases were transferred by vehicles other than an ambulance. Nevertheless, ambulance transportation (either by EMS or by private ambulance) was not associated with a shorter hospital stay. This showed that upgrade of ambulance equipment and training of private ambulance personnel may be needed.
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Affiliation(s)
- Amir Norouzpour
- Department of Epidemiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, IR Iran
- Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Ali Reza Khoshdel
- Department of Epidemiology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Ali Reza Khoshdel, Department of Epidemiology, Faculty of Medicine, AJA University of Medical Sciences, Etemadzadeh Ave., Fatemi St., 16315-781 Tehran, IR Iran. Tel.: +98-2126317336, Fax: +98-2188337909, E-mail:
| | - Mohammad-Hadi Modaghegh
- Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Gholam-Hossein Kazemzadeh
- Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
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O'Reilly GM, Joshipura M, Cameron PA, Gruen R. Trauma registries in developing countries: a review of the published experience. Injury 2013; 44:713-21. [PMID: 23473265 DOI: 10.1016/j.injury.2013.02.003] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 12/26/2012] [Accepted: 02/02/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND The burden of injury is greatest in developing countries. Trauma systems have reduced mortality in developed countries and trauma registries are known to be integral to monitoring and improving trauma care. There are relatively few trauma registries in developing countries and no reviews describing the experience of each registry. The aim of this study was to examine the collective published experience of trauma registries in developing countries. METHODS A structured review of the literature was performed. Relevant abstracts were identified by searching databases for all articles regarding a trauma registry in a developing country. A tool was used to abstract trauma registry details, including processes of data collection and analysis. RESULTS There were 84 articles, 76 of which were sourced from 47 registries. The remaining eight articles were perspectives. Most were from Iran, followed by China, Jamaica, South Africa and Uganda. Only two registries used the Injury Severity Score (ISS) to define inclusion criteria. Most registries collected data on variables from all five variable groups (demographics, injury event, process of care, injury severity and outcome). Several registries collected data for less than a total of 20 variables. Only three registries measured disability using a score. The most commonly used scores of injury severity were the ISS, followed by Revised Trauma Score (RTS), Trauma and Injury Severity Score (TRISS) and the Kampala Trauma Score (KTS). CONCLUSION Amongst the small number of trauma registries in developing countries, there is a large variation in processes. The implementation of trauma systems with trauma registries is feasible in under-resourced environments where they are desperately needed.
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Affiliation(s)
- Gerard M O'Reilly
- Victorian State Trauma Registry, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Commercial Road, Melbourne 3004, Australia.
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Pucher PH, Aggarwal R, Twaij A, Batrick N, Jenkins M, Darzi A. Identifying and Addressing Preventable Process Errors in Trauma Care. World J Surg 2013; 37:752-8. [DOI: 10.1007/s00268-013-1917-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Osime OC, Ighedosa SU, Oludiran OO, Iribhogbe PE, Ehikhamenor E, Elusoji SO. Patterns of Trauma Deaths in an Accident and Emergency Unit. Prehosp Disaster Med 2012; 22:75-8. [PMID: 17484367 DOI: 10.1017/s1049023x00004374] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:Trauma is a leading cause of death in most countries. Different patterns of trauma deaths are recorded in different countries. The purpose of this study was to evaluate retrospectively the pattern of trauma deaths in the emergency unit of a University Teaching Hospital in Nigeria.Methods:This is a descriptive, retrospective study. The data were obtained from patient case files and nurses'records. The data abstracted included age, sex, cause of trauma/death, parts of the body injured, time of death, andthe duration of stay in the Accident and Emergency Unit (AEU).Results:A total of 5,537 cases presented to the AEU of the University of Benin Teaching Hospital between 01 January 2001 and 31 December 2004. Of these, 5,446 were due to trauma (98.4%). A total of 127 patients died (case fatality rate: 2.3%). Of the deaths, 81.9% were males. Motor vehicle crashes were the most frequent cause (54.3%), and drowning was the least common cause of trauma (0.8%). The most frequently injured region of the body was the head and neck (53.4%). A total of 67.4% of the deaths occurred within six hours of presentation to the AEU.Conclusions:There is a great need for improved road safety, adequate pre-hospital medical care, and prompt transfer services for victims of trauma.
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Affiliation(s)
- Odigie Clement Osime
- Department of Surgery, University of Benin Teaching Hospital, PMB 1111, Benin City, Nigeria.
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35
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Settervall CHC, Domingues CDA, Sousa RMCD, Nogueira LDS. Preventable trauma deaths. Rev Saude Publica 2012; 46:367-75. [PMID: 22310649 DOI: 10.1590/s0034-89102012005000010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Accepted: 09/15/2011] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe methods of estimation and assess preventable deaths and types of errors related to health care. METHODS A systematic review of articles on preventable trauma deaths published between 2000 and 2009 was conducted. Lilacs, SciELO and Medline databases were searched using the keywords "trauma," "avoidable," "preventable," "interventions" and "complications" and the health sciences descriptors "death," "cause of death," and "hospitals." RESULTS A total of 29 articles published during the study period were selected. Most were retrospective studies (96.5%). The most common methods used to define avoidability of death were expert panel and injury severity scores. Deaths were categorized as follows: preventable; potentially preventable; and not preventable. The mean preventable death rate was 10.7% (SD 11.5%). The most commonly reported errors were inadequate care management of injured patients and evaluation and treatment errors. CONCLUSIONS Inconsistent terms were used to categorize deaths and related noncompliances. It is suggested to standardize the terminology for the classification of deaths and types of errors.
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Haghparast-Bidgoli H, Khankeh H, Johansson E, Yarmohammadian MH, Hasselberg M. Exploring the provision of hospital trauma care for road traffic injury victims in Iran: a qualitative approach. J Inj Violence Res 2011; 5:28-37. [PMID: 22095003 PMCID: PMC3591729 DOI: 10.5249/jivr.v5i1.195] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 11/12/2011] [Indexed: 11/09/2022] Open
Abstract
Background: Identifying factors affecting the provision of trauma care is essential for improving the quality of care for road traffic injury (RTI) victims. The study aimed to explore the perceptions and experiences of trauma care among injured patients and health professionals to identify factors influencing an effective trauma care delivery at emergency departments (EDs) in Iran. Methods: The study was conducted with a grounded theory approach. The study participants consisted of 15 health professionals and 20 injured patients. The data were collected via semi-structured interviews and were analyzed using constant comparative analysis method. Results: Lack of a systematic approach to providing trauma care at EDs emerged as the core category. The leading factors in the development of the core category were unclear national policies and poor organization of care at the ED. Other major factors were contextual factors in the environment of the hospitals such as inappropriate structure and unsupportive environment and also factors specific to the context of Iran such as a rapid increase in the number of traumas. Professionals reacted to the prevailing conditions in ways that contributed to an ineffective trauma care, even though strategies employed by Emergency Medicine Physicians (EMPs) improved the quality of trauma care locally. Conclusions: Building a national trauma system, using available professional resources especially EMPs, and implementing low cost and evidence-based improvements such as establishing trauma teams and trauma training for staff working at the EDs on a regular basis is necessary in order to improve delivery of trauma care at the hospitals.
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Affiliation(s)
- Hassan Haghparast-Bidgoli
- Health Management and Economics Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran
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37
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Saltzherr TP, Wendt KW, Nieboer P, Nijsten MWN, Valk JP, Luitse JSK, Ponsen KJ, Goslings JC. Preventability of trauma deaths in a Dutch Level-1 trauma centre. Injury 2011; 42:870-3. [PMID: 20435305 DOI: 10.1016/j.injury.2010.04.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 04/07/2010] [Accepted: 04/07/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND Monitoring the quality of trauma care is frequently done by analysing the preventability of trauma deaths and errors during trauma care. In the Academic Medical Center trauma deaths are discussed during a monthly Morbidity and Mortality meeting. In this study an external multidisciplinary panel assessed the trauma deaths and errors in management of a Dutch Level-1 trauma centre for (potential) preventability. METHODS All patients who died during or after presentation in the trauma resuscitation room in a 2-year period were eligible for review. All information on trauma evaluation and management was summarised by an independent research fellow. An external multidisciplinary panel individually evaluated the cases for preventability of death. Potential errors or mismanagements during the admission were classified for type, phase and domain. Overall agreement on (potential) preventability was compared between the external panel and the internal M&M consensus. RESULTS Of the 62 evaluated trauma deaths one was judged as preventable and 17 were judged as potentially preventable by the review panel. Overall agreement on preventability between the review panel and the internal consensus was moderate (Kappa 0.51). The external panel judged one death as preventable compared with three from the internal consensus. The interobserver agreement between the external panel members was also moderate (Kappa 0.43). The panel judged 31 errors to have occurred in the (potential) preventable death group and 23 errors in the non-preventable death group. Such errors included choice or sequence of diagnostics, rewarming of hypothermic patients, and correction of coagulopathies. CONCLUSIONS The preventable death rate in the present study was comparable to data in the available literature. Compared to internal review, the external, multidisciplinary review did not find a higher preventable death rate, although it provided several insights to optimise trauma care.
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Affiliation(s)
- T P Saltzherr
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Haghparast-Bidgoli H, Hasselberg M, Khankeh H, Khorasani-Zavareh D, Johansson E. Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach. BMC Emerg Med 2010; 10:20. [PMID: 21059243 PMCID: PMC2992044 DOI: 10.1186/1471-227x-10-20] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 11/08/2010] [Indexed: 12/04/2022] Open
Abstract
Background Road traffic injuries are a major global public health problem. Improvements in pre-hospital trauma care can help minimize mortality and morbidity from road traffic injuries (RTIs) worldwide, particularly in low- and middle-income countries (LMICs) with a high rate of RTIs such as Iran. The current study aimed to explore pre-hospital trauma care process for RTI victims in Iran and to identify potential areas for improvements based on the experience and perception of pre-hospital trauma care professionals. Methods A qualitative study design using a grounded theory approach was selected. The data, collected via in-depth interviews with 15 pre-hospital trauma care professionals, were analyzed using the constant comparative method. Results Seven categories emerged to describe the factors that hinder or facilitate an effective pre-hospital trauma care process: (1) administration and organization, (2) staff qualifications and competences, (3) availability and distribution of resources, (4) communication and transportation, (5) involved organizations, (6) laypeople and (7) infrastructure. The core category that emerged from the other categories was defined as "interaction and common understanding". Moreover, a conceptual model was developed based on the categories. Conclusions Improving the interaction within the current pre-hospital trauma care system and building a common understanding of the role of the Emergency Medical Services (EMS) emerged as key issues in the development of an effective pre-hospital trauma care process.
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Affiliation(s)
- Hassan Haghparast-Bidgoli
- Division of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden.
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A Model of Personnel Mobilization during Mass-Casualty Incidents. Prehosp Disaster Med 2010. [DOI: 10.1017/s1049023x0002330x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Management of traumatic liver injuries without a valid trauma system. Prehosp Disaster Med 2009; 24:349-55. [PMID: 19806560 DOI: 10.1017/s1049023x00007081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Despite a global increase in conservative treatment of blunt liver injuries, the number of surgically treated traumas in one major trauma center in Iran has increased. The aim of this study was to unveil the reasons behind this increase in operative management by studying 228 consecutive patients at this regional center. HYPOTHESIS The increased number of liver injuries operated upon is due to the lack of a solid, well-defined trauma system. METHODS A retrospective review of all patients admitted for liver trauma at Bahonar Hospital, Kerman, Iran, from March 2001 until March 2006 was conducted. Patient data were collected, studied and statistically processed with regard to demographics, clinical and laboratory findings, surgical procedures, complications, and mortality. RESULTS All patients who were admitted between 30-360 minutes after injury were included. Twelve hemodynamically stable patients were treated conservatively in an ordinary surgical ward. The remaining 216 patients, 153 of whom had blunt injuries, were hemodynamically unstable. A total of 70 patients were in hemorrhagic shock at the time of arrival. Hemodynamically unstable patients with either the suspicion of associated injuries and/or who displayed clinical deterioration and could not be observed in an ordinary surgical ward were treated surgically. The majority of patients who were operated upon in this series had a grade-II liver injury. The total mortality rate in surgically treated patients was 18.1%. None of the patients treated conservatively died. CONCLUSIONS Despite the low grade of their liver injuries, the high number of surgically treated patients in this series was due to the absence of a valid trauma system. This result should encourage the authorities to review current trauma systems and trauma surgical guidelines.
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Chua WC, D'Amours SK, Sugrue M, Caldwell E, Brown K. Performance and consistency of care in admitted trauma patients: our next great opportunity in trauma care? ANZ J Surg 2009; 79:443-8. [DOI: 10.1111/j.1445-2197.2009.04946.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Quansah R, Abantanga F, Donkor P. Trauma training for nonorthopaedic doctors in low- and middle-income countries. Clin Orthop Relat Res 2008; 466:2403-12. [PMID: 18688692 PMCID: PMC2584316 DOI: 10.1007/s11999-008-0401-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 07/02/2008] [Indexed: 01/31/2023]
Abstract
Increasingly, nonspecialist Ghanaian doctors in district hospitals are called upon to perform a variety of surgical procedures for which they have little or no training. They are also required to provide initial stabilization for the injured and, in some cases, provide definitive management where referral is not possible. Elsewhere continuing medical education courses in trauma have improved the delivery of trauma care. Development of such courses must meet the realities of a low-income country. The Department of Surgery, Kwame Nkrumah University of Science and Technology developed a week-long trauma continuing medical education course for doctors in rural districts. The course was introduced in 1997, and has been run annually since. The trauma course specifically addresses the critical issues of trauma care in Ghana. It has improved the knowledge base of doctors, as well as their self-reported process of trauma care. Through the process we have learned lessons that could help in the efforts to improve trauma training and trauma care in other low-income countries.
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Affiliation(s)
- Robert Quansah
- Department of Surgery, School of Medical Sciences, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, P.O. Box 1934, Kumasi, Ghana
| | - Francis Abantanga
- Department of Surgery, School of Medical Sciences, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, P.O. Box 1934, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medical Sciences, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, P.O. Box 1934, Kumasi, Ghana
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Preventable Deaths Among Trauma Patients. POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0016-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Teixeira PGR, Inaba K, Hadjizacharia P, Brown C, Salim A, Rhee P, Browder T, Noguchi TT, Demetriades D. Preventable or potentially preventable mortality at a mature trauma center. THE JOURNAL OF TRAUMA 2007; 63:1338-1347. [PMID: 18212658 DOI: 10.1097/ta.0b013e31815078ae] [Citation(s) in RCA: 238] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The objective of this study was to analyze the preventable and potentially preventable deaths occurring at a mature Level I trauma center. METHODS All trauma patients that died during their initial hospital admission during an 8-year period (January, 1998 to December, 2005) were analyzed. The deaths were initially reviewed at a weekly Morbidity and Mortality (M&M) conference followed by a multidisciplinary (Trauma Surgery, Critical Care, Emergency Medicine, Neurosurgery, Nursing, and Coroner) Combined Trauma Death Review Committee, and were classified into nonpreventable, potentially preventable, and preventable deaths. All preventable and potentially preventable deaths were identified for the purpose of the study. Quality improvement death forms included data on epidemiology, vital signs, injury severity, type of injury, probability of survival with Trauma and Injury Severity Score methodology, preventability (nonpreventable, potentially preventable, and preventable deaths), errors in the evaluation and management of the patient, and classification of errors (system, judgment, knowledge). Additional injury details, clinical course, circumstances leading to the death and autopsy findings were abstracted from the trauma registry and individual chart review. RESULTS During the study period, 35,311 patients meeting trauma registry criteria were admitted and a total of 2,081 (5.9%) deaths occurred. Fifty-one deaths were classified as preventable or potentially preventable deaths (0.1% of admissions, 2.5% of deaths). Eleven of them (0.53% of deaths) were classified as preventable and 40 (1.92% of deaths) as potentially preventable deaths. Mean age was 40 years, 66.7% were men, mean Injury Severity Score was 27, 74.5% were blunt. The most common cause of death was bleeding (20, 39.2%) followed by multiple organ dysfunction syndrome (14, 27.5%) and cardiorespiratory arrest (8, 15.6%). This was caused by a delay in treatment (27, 52.9%), clinical judgment error (11, 21.6%), missed diagnosis (6, 11.8%), technical error (4, 7.8%), and other (3, 5.9%). The deaths peaked at two time periods: 26 (51.1%) during the first 24 hours and 16 (31.4%) after 7 days. Only one patient (2.0%) died in the first hour. The most common location of death was the intensive care unit (28, 54.9%), operating room (13, 25.5%), and emergency room (5, 9.8%). CONCLUSION Preventable or potentially preventable deaths are rare but do occur at an academic Level I trauma center. Delay in treatment and error in judgment are the leading causes of preventable and potentially preventable deaths.
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Affiliation(s)
- Pedro G R Teixeira
- Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, University of Southern California, Los Angeles, California, USA
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Smith JP, Shokoohi H, Holliman JC. The Search for Common Ground: Developing Emergency Medicine in Iran. Acad Emerg Med 2007. [DOI: 10.1111/j.1553-2712.2007.tb01808.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mock C, Nguyen S, Quansah R, Arreola-Risa C, Viradia R, Joshipura M. Evaluation of Trauma Care Capabilities in Four Countries Using the WHO-IATSIC Guidelines for Essential Trauma Care. World J Surg 2006; 30:946-56. [PMID: 16736320 DOI: 10.1007/s00268-005-0768-4] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND We sought to identify affordable and sustainable methods to strengthen trauma care capabilities globally, especially in developing countries, using the Guidelines for Essential Trauma Care. These guidelines were created by the World Health Organization (WHO) and the International Society of Surgery and provide recommendations on elements of trauma care that should be in place at the range of health facilities globally. METHODS The guidelines were used as a basis for needs assessments in 4 countries selected to represent the world's range of geographic and economic conditions: Mexico (middle income; Latin America); Vietnam (low income; east Asia); India (low income; south Asia); and Ghana (low income; Africa). One hundred sites were assessed, including rural clinics (n=51), small hospitals (n=34), and large hospitals (n=15). Site visits utilized direct inspection and interviews with administrative and clinical staff. RESULTS Resources were partly adequate or adequate at most large hospitals, but there were gaps that could be improved, especially in low-income settings, such as shortages of airway equipment, chest tubes, and trauma-related medications; and prolonged periods where critical equipment (e.g., X-ray, laboratory) were unavailable while awaiting repairs. Rural clinics everywhere had difficulties with basic supplies for resuscitation even though some received significant trauma volumes. In all settings, there was a dearth of administrative functions to assure quality trauma care, including trauma registries, trauma-related quality improvement programs, and regular in-service training. CONCLUSIONS This study identified several low-cost ways in which to strengthen trauma care globally. It also has demonstrated the usefulness of the Guidelines for Essential Trauma Care in providing an internationally applicable, standardized template by which to assess trauma care capabilities.
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Affiliation(s)
- Charles Mock
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
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