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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
Article

Abstract

Background

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.

Results

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.

Conclusions

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.

Keywords

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.

Abbreviations

A+

Autopsy performed

A−

No autopsy performed

AAST

American Association for the Surgery of Trauma

AIS

Abbreviated injury severity score

CPR

Cardiopulmonary resuscitation

CT

Computer tomography

DP

Definitely preventable death

ED

Emergency department

EMT

Emergency medical technician

HEMS

Helicopter emergency medical service

ICU

Intensive care unit

i.v.

Intra-Venous

NAW

Emergency physician and paramedic staffed ambulance

NP

Non-Preventable death

OR

Operation room

PP

Preventable death

sTBI

Severe traumatic brain injury

tCPR

Traumatic cardio-pulmonary resuscitation

Notes

Acknowledgments

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.

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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

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