World Journal of Surgery

, Volume 37, Issue 5, pp 1154–1161 | Cite as

Trauma-related Preventable Deaths in Berlin 2010: Need to Change Prehospital Management Strategies and Trauma Management Education

  • C. Kleber
  • M. T. Giesecke
  • M. Tsokos
  • N. P. Haas
  • C. T. Buschmann



Fatal trauma is one of the leading causes of death in Western industrialized countries. The aim of the present study was to determine the preventability of traumatic deaths, analyze the medical measures related to preventable deaths, detect management failures, and reveal specific injury patterns in order to avoid traumatic deaths in Berlin.

Materials and methods

In this prospective observational study all autopsied, direct trauma fatalities in Berlin in 2010 were included with systematic data acquisition, including police files, medical records, death certificates, and autopsy records. An interdisciplinary expert board judged the preventability of traumatic death according to the classification of non-preventable (NP), potentially preventable (PP), and definitively preventable (DP) fatalities.


Of the fatalities recorded, 84.9 % (n = 224) were classified as NP, 9.8 % (n = 26) as PP, and 5.3 % (n = 14) as DP. The incidence of severe traumatic brain injury (sTBI) was significantly lower in PP/DP than in NP, and the incidence of fatal exsanguinations was significantly higher. Most PP and NP deaths occurred in the prehospital setting. Notably, no PP or DP was recorded for fatalities treated by a HEMS crew. Causes of DP deaths consisted of tension pneumothorax, unrecognized trauma, exsanguinations, asphyxia, and occult bleeding with a false negative computed tomography scan.


The trauma mortality in Berlin, compared to worldwide published data, is low. Nevertheless, 15.2 % (n = 40) of traumatic deaths were classified as preventable. Compulsory training in trauma management might further reduce trauma-related mortality. The main focus should remain on prevention programs, as the majority of the fatalities occurred as a result of non-survivable injuries.


Emergency Physician Helicopter Emergency Medical Service Preventable Death Prehospital Setting Traumatic Death 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Autopsy performed


No autopsy performed


American Association for the Surgery of Trauma


Abbreviated injury severity score


Cardiopulmonary resuscitation


Computer tomography


Definitely preventable death


Emergency department


Emergency medical technician


Helicopter emergency medical service


Intensive care unit




Emergency physician and paramedic staffed ambulance


Non-Preventable death


Operation room


Preventable death


Severe traumatic brain injury


Traumatic cardio-pulmonary resuscitation



Contributions were made possible by DFG funding through the Berlin-Brandenburg School for Regenerative Therapies GSC 203. The authors are grateful to Dr. Paul Bedford for his contribution to the manuscript.


  1. 1.
    Pfeifer R, Tarkin IS, Rocos B et al (2009) Patterns of mortality and causes of death in polytrauma patients—has anything changed? Injury 40:907–911PubMedCrossRefGoogle Scholar
  2. 2.
    Ottosson A, Krantz P (1984) Traffic fatalities in a system with decentralized trauma care. A study with special reference to potentially salvageable casualties. JAMA 251:2668–2671PubMedCrossRefGoogle Scholar
  3. 3.
    Zollinger RW (1955) Traffic injuries; a surgical problem. AMA Arch Surg 70:694–700PubMedCrossRefGoogle Scholar
  4. 4.
    Kleber C, Lefering R, Kleber AJ et al (2012) Rettungszeit und Überleben von Schwerverletzten in Deutschland. Unfallchirurg. doi: 10.1007/s00113-011-2132-5
  5. 5.
    Arnold JL (1999) International emergency medicine and the recent development of emergency medicine worldwide. Ann Emerg Med 33:97–103PubMedCrossRefGoogle Scholar
  6. 6.
    Dick WF (2003) Anglo-American vs. Franco-German emergency medical services system. Prehosp disaster med 18:29–35 discussion 35–27PubMedGoogle Scholar
  7. 7.
    Probst C, Pape HC, Hildebrand F et al (2009) 30 years of polytrauma care: an analysis of the change in strategies and results of 4849 cases treated at a single institution. Injury 40:77–83PubMedCrossRefGoogle Scholar
  8. 8.
    Kleber C, Giesecke MT, Tsokos M et al (2012) Overall distribution of trauma-related deaths in Berlin 2010: advancement or stagnation of German trauma management? World J Surg 36:2125–2130. doi: 10.1007/s00268-012-1650-9
  9. 9.
    Mock C, Quansah R, Krishnan R et al (2004) Strengthening the prevention and care of injuries worldwide. Lancet 363(9427):2172–2179PubMedCrossRefGoogle Scholar
  10. 10.
    Bakke HK, Wisborg T (2011) Rural high north: a high rate of fatal injury and prehospital death. World J Surg 35:1615–1620. doi: 10.1007/s00268-011-1102-y PubMedCrossRefGoogle Scholar
  11. 11.
    Van Wagoner FH (1961) A three year study of deaths following trauma. J Trauma 1:401–408Google Scholar
  12. 12.
    Chen XP, Losman JA, Cowan S et al (2002) Pim serine/threonine kinases regulate the stability of Socs-1 protein. Proc Natl Acad Sci U S A 99:2175–2180PubMedCrossRefGoogle Scholar
  13. 13.
    MacKenzie EJ, Steinwachs DM, Bone LR et al (1992) Inter-rater reliability of preventable death judgments. The Preventable Death Study Group. J Trauma 33:292–302 discussion 302–303PubMedCrossRefGoogle Scholar
  14. 14.
    Shackford SR, Hollingsworth-Fridlund P, McArdle M et al (1987) Assuring quality in a trauma system—the Medical Audit Committee: composition, cost, and results. J Trauma 27:866–875PubMedCrossRefGoogle Scholar
  15. 15.
    Mock CN, Jurkovich GJ, nii-Amon-Kotei D et al (1998) Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma 44(5):804–812 discussion 812–814PubMedCrossRefGoogle Scholar
  16. 16.
    Roy MS, Gosselin J, Hanna N et al (2004) Influence of the state of alertness on the pattern visual evoked potentials (PVEP) in very young infant. Brain Dev 26:197–202PubMedCrossRefGoogle Scholar
  17. 17.
    Buschmann CT, Gahr P, Tsokos M et al (2010) Clinical diagnosis versus autopsy findings in polytrauma fatalities. Scand J Trauma Resusc Emerg Med 18:55PubMedCrossRefGoogle Scholar
  18. 18.
    Jat AA, Khan MR, Zafar H et al (2004) Peer review audit of trauma deaths in a developing country. Asian J Surg 27:58–64PubMedCrossRefGoogle Scholar
  19. 19.
    Limb D, McGowan A, Fairfield JE et al (1996) Prehospital deaths in the Yorkshire Health Region. J Accid Emerg Med 13:248–250PubMedCrossRefGoogle Scholar
  20. 20.
    Papadopoulos IN, Bukis D, Karalas E et al (1996) Preventable prehospital trauma deaths in a Hellenic urban health region: an audit of prehospital trauma care. J Trauma 41:864–869PubMedCrossRefGoogle Scholar
  21. 21.
    West JG, Trunkey DD, Lim RC (1979) Systems of trauma care. A study of two counties. Arch Surg 114:455–460PubMedCrossRefGoogle Scholar
  22. 22.
    Draaisma JM, de Haan AF, Goris RJ (1989) Preventable trauma deaths in The Netherlands—a prospective multicenter study. J Trauma 29:1552–1557PubMedCrossRefGoogle Scholar
  23. 23.
    Stocchetti N, Pagliarini G, Gennari M et al (1994) Trauma care in Italy: evidence of in-hospital preventable deaths. J Trauma 36:401–405PubMedCrossRefGoogle Scholar
  24. 24.
    Shackford SR, Hollingworth-Fridlund P, Cooper GF et al (1986) The effect of regionalization upon the quality of trauma care as assessed by concurrent audit before and after institution of a trauma system: a preliminary report. J Trauma 26:812–820PubMedCrossRefGoogle Scholar
  25. 25.
    McDermott FT, Cooper GJ, Hogan PL et al (2005) Evaluation of the prehospital management of road traffic fatalities in Victoria, Australia. Prehosp Disaster Med 20:219–227PubMedGoogle Scholar
  26. 26.
    McDermott FT, Cordner SM, Tremayne AB (1996) Evaluation of the medical management and preventability of death in 137 road traffic fatalities in Victoria, Australia: an overview. Consultative Committee on Road Traffic Fatalities in Victoria. J Trauma 40:520–533 discussion 533–525PubMedCrossRefGoogle Scholar
  27. 27.
    Davis JW, Hoyt DB, McArdle MS et al (1992) An analysis of errors causing morbidity and mortality in a trauma system: a guide for quality improvement. J Trauma 32:660–665 discussion 665–666PubMedCrossRefGoogle Scholar
  28. 28.
    Ashour A, Cameron P, Bernard S et al (2007) Could bystander first-aid prevent trauma deaths at the scene of injury? Emerg Med Australas 19:163–168PubMedCrossRefGoogle Scholar
  29. 29.
    Sanddal TL, Esposito TJ, Whitney JR et al (2011) Analysis of preventable trauma deaths and opportunities for trauma care improvement in Utah. J Trauma 70:970–977PubMedCrossRefGoogle Scholar
  30. 30.
    Anderson ID, Woodford M, de Dombal FT et al (1988) Retrospective study of 1,000 deaths from injury in England and Wales. Br Med J (Clin Res Ed) 296(6632):1305–1308CrossRefGoogle Scholar
  31. 31.
    Frink M, Probst C, Hildebrand F et al (2007) The influence of transportation mode on mortality in polytraumatized patients. An analysis based on the German Trauma Registry. Unfallchirurg 110:334–340PubMedCrossRefGoogle Scholar
  32. 32.
    Esposito TJ, Sanddal ND, Hansen JD et al (1995) Analysis of preventable trauma deaths and inappropriate trauma care in a rural state. J Trauma 39:955–962PubMedCrossRefGoogle Scholar
  33. 33.
    Maio RF, Burney RE, Gregor MA et al (1996) A study of preventable trauma mortality in rural Michigan. J Trauma 41:83–90PubMedCrossRefGoogle Scholar
  34. 34.
    Haas NP, Hoffmann RF, Mauch C et al (1995) The management of polytraumatized patients in Germany. Clin Orthop Relat Res 318:25–35PubMedGoogle Scholar
  35. 35.
    Davies GE, Lockey DJ (2011) Thirteen survivors of prehospital thoracotomy for penetrating trauma: a prehospital physician-performed resuscitation procedure that can yield good results. J Trauma 70:E75–E78PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • C. Kleber
    • 1
    • 2
  • M. T. Giesecke
    • 1
  • M. Tsokos
    • 3
  • N. P. Haas
    • 1
  • C. T. Buschmann
    • 3
  1. 1.Center for Musculoskeletal Surgery, AG PolytraumaCharité–Universitätsmedizin BerlinBerlinGermany
  2. 2.Berlin-Brandenburg Center for Regenerative TherapiesCharité–Universitätsmedizin BerlinBerlinGermany
  3. 3.Institute of Legal Medicine and Forensic SciencesCharité–Universitätsmedizin BerlinBerlinGermany

Personalised recommendations