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.
Similar content being viewed by others
Abbreviations
- AIS:
-
Abbreviated Injury Scale
- bpm:
-
Beats per minute
- CT:
-
Computed tomography
- DGU:
-
German Society for Trauma Surgery
- EMS:
-
Emergency medical system
- GCS:
-
Glasgow Coma Scale
- Hb:
-
Hemoglobin
- ICU:
-
Intensive care unit
- ISS:
-
Injury Severity Score
- M&M:
-
Morbidity and mortality conference
- MOF:
-
Multi-organ failure
- RISC:
-
Revised injury severity classification
- SPSS:
-
Statistical Package for the Social Sciences
- TRISS:
-
Trauma and Injury Severity Score
References
Bevölkerung - Alter im Wandel - Ältere Menschen in Deutschland und der EU - Statistisches Bundesamt (Destatis). https://www.destatis.de/DE/Publikationen/Thematisch/Bevoelkerung/Bevoelkerungsstand/AlterimWandel.html. Accessed 05 May 2014
Goodmanson NW, Rosengart MR, Barnato AE, Sperry JL, Peitzman AB, Marshall GT (2012) Defining geriatric trauma: when does age make a difference? Surgery 152(4):668–674 discussion:674–5
Taylor MD, Tracy JK, Meyer W, Pasquale M, Napolitano LM (2002) Trauma in the elderly: intensive care unit resource use and outcome. J Trauma 53(3):407–414
Newell MA, Rotondo MF, Toschlog EA, Waibel BH, Sagraves SG, Schenarts PJ, Bard MR, Goettler CE (2009) The elderly trauma patient: an investment for the future? J Trauma 67(2):337–340
Scalea TM, Simon HM, Duncan AO, Atweh NA, Sclafani SJ, Phillips TF, Shaftan GW (1990) Geriatric blunt multiple trauma: improved survival with early invasive monitoring. J Trauma 30(2):129–134 discussion: 134–6
Victorino GP, Chong TJ, Pal JD (2003) Trauma in the elderly patient. Arch Surg 138(10):1093–1098
Lehmann R, Beekley A, Casey L, Salim A, Martin M (2009) The impact of advanced age on trauma triage decisions and outcomes: a statewide analysis. Am J Surg 197(5):571–574 discussion: 574–5
Martin JT, Alkhoury F, O’Connor JA, Kyriakides TC, Bonadies JA (2010) ‘Normal’ vital signs belie occult hypoperfusion in geriatric trauma patients. Am Surg 76(1):65–69
Pellicane JV, Byrne K, DeMaria EJ (1992) Preventable complications and death from multiple organ failure among geriatric trauma victims. J Trauma 33(3):440–444
MacKenzie EJ (1999) Review of evidence regarding trauma system effectiveness resulting from panel studies. J Trauma 47(3 Suppl):S34–S41
Shackford SR, Hollingsworth-Fridlund P, McArdle M, Eastman AB (1987) Assuring quality in a trauma system: the Medical Audit Committee: composition, cost, and results. J Trauma 27(8):866–875
Reason JT (2001) Understanding adverse events: the human factor. In: Vincent C (ed) Clinical risk management: enhancing patient safety. BMJ Books, London, pp 6–30
German Trauma Society (DGU): S3 – Guideline on Treatment of Patients with Severe and Multiple Injuries. [http://www.awmf.org/fileadmin/user_upload/Leitlinien/012_D_Ges_fuer_Unfallchirurgie/012-019e_S3_Severe_and_Multiple_Injuries_2012-11.pdf]. Accessed: 05 May 2014
Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent J, Rossaint R (2013) Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care 17(2):R76
Schoeneberg C, Schilling M, Keitel J, Kauther MD, Burggraf M, Hussmann B, Lendemans S (2014) TraumaNetwork, Trauma Registry of the DGU®, Whitebook, S3 Guideline on treatment of polytrauma/severe injuries: an approach for validation by a retrospective analysis of 2304 patients (2002–2011) of a level 1 trauma centre. Zentralbl Chir. doi:10.1055/s-0033-1360225
Kleber C, Giesecke MT, Tsokos M, Haas NP, Buschmann CT (2013) Trauma-related preventable deaths in Berlin 2010: need to change prehospital management strategies and trauma management education. World J Surg 37(5):1154–1161. doi:10.1007/s00268-013-1964-2
Anderson ID, Woodford M, de Dombal FT, Irving M (1988) Retrospective study of 1000 deaths from injury in England and Wales. Br Med J (Clin Res Ed) 296(6632):1305–1308
Kreis DJ, Plasencia G, Augenstein D, Davis JH, Echenique M, Vopal J, Byers P, Gomez G (1986) Preventable trauma deaths: Dade County, Florida. J Trauma 26(7):649–654
Stocchetti N, Pagliarini G, Gennari M, Baldi G, Banchini E, Campari M, Bacchi M, Zuccoli P (1994) Trauma care in Italy: evidence of in-hospital preventable deaths. J Trauma 36(3):401–405
Zafarghandi M, Modaghegh MS, Roudsari BS (2003) Preventable trauma death in Tehran: an estimate of trauma care quality in teaching hospitals. J Trauma 55(3):459–465
Teixeira Pedro G R, Inaba K, Hadjizacharia P, Brown C, Salim A, Rhee P, Browder T, Noguchi TT, Demetriades D (2007) Preventable or potentially preventable mortality at a mature trauma center. J Trauma 63(6):1338–1346 discussion 1346–7
Davis JW, Hoyt DB, McArdle MS, Mackersie RC, Eastman AB, Virgilio RW, Cooper G, Hammill F, Lynch FP (1992) An analysis of errors causing morbidity and mortality in a trauma system: a guide for quality improvement. J Trauma 32(5):660–665 discussion 665–6
Gruen RL, Jurkovich GJ, McIntyre LK, Foy HM, Maier RV (2006) Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg 244(3):371–380
Dutton RP, Stansbury LG, Leone S, Kramer E, Hess JR, Scalea TM (2010) Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns, 1997–2008. J Trauma 69(3):620–626
Cobas MA, De la Peña MA, Manning R, Candiotti K, Varon AJ (2009) Prehospital intubations and mortality: a level 1 trauma center perspective. Anesth Analg 109(2):489–493
Wang HE, Cook LJ, Chang CH, Yealy DM, Lave JR (2009) Outcomes after out-of-hospital endotracheal intubation errors. Resuscitation 80(1):50–55
Albrecht E, Yersin B, Spahn DR, Fishman D, Hugli O (2006) Success rate of airway management by residents in a pre-hospital emergency setting: a retrospective study. Eur J Trauma 32(6):516–522
Nakstad AR, Heimdal H, Strand T, Sandberg M (2011) Incidence of desaturation during prehospital rapid sequence intubation in a physician-based helicopter emergency service. Am J Emerg Med 29(6):639–644
Rognås L, Hansen TM, Kirkegaard H, Tønnesen E (2013) Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scand J Trauma Resusc Emerg Med 21:58
Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ (2002) Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma 52(3):420–425
Hussmann B, Lefering R, Waydhas C, Touma A, Kauther MD, Ruchholtz S, Lendemans S (2013) Does increased prehospital replacement volume lead to a poor clinical course and an increased mortality? A matched-pair analysis of 1896 patients of the Trauma Registry of the German Society for Trauma Surgery who were managed by an emergency doctor at the accident site. Injury 44(5):611–617
Ley EJ, Clond MA, Srour MK, Barnajian M, Mirocha J, Margulies DR, Salim A (2011) Emergency department crystalloid resuscitation of 1.5 L or more is associated with increased mortality in elderly and nonelderly trauma patients. J Trauma 70(2):398–400
Schoeneberg C, Schilling M, Burggraf M, Fochtmann U, Lendemans S (2014) Reduction in mortality in severely injured patients following the introduction of the “Treatment of patients with severe and multiple injuries” guideline of the German society of trauma surgery: a retrospective analysis of a level 1 trauma center (2010–2012). Injury 45(3):635–638
Huber-Wagner S, Lefering R, Qvick L, Körner M, Kay MV, Pfeifer K, Reiser M, Mutschler W, Kanz K (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373(9673):1455–1461
Conflict of interest
There are no conflicts of interest among the authors.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Schoeneberg, C., Schilling, M., Probst, T. et al. Preventable and Potentially Preventable Deaths in Severely Injured Elderly Patients: A Single-Center Retrospective Data Analysis of a German Trauma Center. World J Surg 38, 3125–3132 (2014). https://doi.org/10.1007/s00268-014-2755-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-014-2755-0