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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References
Ruchholtz S, Lefering R, Paffrath T, et al. Reduction in mortality of severely injured patients in Germany. Dtsch Arztebl Int. 2008;105(13):225–31.
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; 2012. Accessed 28 Dec 2015.
Gertner HR, Baker SP, Rutherford RB, et al. Evaluation of the management of vehicular fatalities secondary to abdominal injury. J Trauma. 1972;12(5):425–31.
West JG, Trunkey DD, Lim RC. Systems of trauma care. A study of two counties. Arch Surg. 1979;114(4):455–60.
West JG, Cales RH, Gazzaniga AB. Impact of regionalization. The Orange County experience. Arch Surg. 1983;118(6):740–4.
Potoka DA, Schall LC, Gardner MJ, et al. Impact of pediatric trauma centers on mortality in a statewide system. J Trauma. 2000;49(2):237–45.
Potoka DA, Schall LC, Ford HR. Improved functional outcome for severely injured children treated at pediatric trauma centers. J Trauma. 2001;51(5):824–32 (discussion 832–4).
Reason JT. Understanding adverse events: the human factor. In: Vincent C, editor. Clinical risk management: enhancing patient safety. London: BMJ Books; 2001. p. 6–30.
German Trauma Society. 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 28 Dec 2015.
Spahn DR, Bouillon B, Cerny V, et al. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care. 2013;17(2):R76.
Schoeneberg C, Schilling M, Keitel J, et al. Trauma Network, Trauma Registry of the DGU(R), 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. 2014 [epub ahead of print]. doi:10.1055/s-0033-1360225.
World Health Organization (WHO). Guidelines for trauma quality improvement programmes. http://www.who.int/violence_injury_prevention/services/traumacare/traumaguidelines/en/; 2009. Accessed 28 Dec 2015.
Kleber C, Giesecke MT, Tsokos M, et al. Trauma-related preventable deaths in Berlin 2010: need to change prehospital management strategies and trauma management education. World J Surg. 2013;37(5):1154–61.
Settervall CH, Domingues CDA, Sousa RM, et al. Preventable trauma deaths. Rev Saude Publica. 2012;46(2):367–75.
Teixeira PG, Inaba K, Hadjizacharia P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma. 2007;63(6):1338–46 (discussion 1346–7).
Davis JW, Hoyt DB, McArdle, et al. An analysis of errors causing morbidity and mortality in a trauma system: a guide for quality improvement. J Trauma. 1992;32(5):660–5 (discussion 665–6).
Gruen RL, Jurkovich GJ, McIntyre LK, et al. Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg. 2006;244(3):371–80.
Anderson ID, Woodford M, de Dombal FT, et al. Retrospective study of 1000 deaths from injury in England and Wales. Br Med J (Clin Res Ed). 1988;296(6632):1305–8.
Kreis DJ, Plasencia G, Augenstein D, et al. Preventable trauma deaths: Dade County, Florida. J Trauma. 1986;26(7):649–54.
Stocchetti N, Pagliarini G, Gennari M, et al. Trauma care in Italy: evidence of in-hospital preventable deaths. J Trauma. 1994;36(3):401–5.
Zafarghandi M, Modaghegh MS, Roudsari BS. Preventable trauma death in Tehran: an estimate of trauma care quality in teaching hospitals. J Trauma. 2003;55(3):459–65.
Clarke JR, Trooskin SZ, Doshi PJ, et al. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma. 2002;52(3):420–5.
Schoeneberg C, Schilling M, Burggraf M, et al. 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. 2014;45(3):635–8.
Pape H, Grimme K, van Griensven M, et al. Impact of intramedullary instrumentation versus damage control for femoral fractures on immunoinflammatory parameters: prospective randomized analysis by the EPOFF Study Group. J Trauma. 2003;55(1):7–13.
Hussmann B, Lefering R, Waydhas C, et al. 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. 2013;44(5):611–7.
Haut ER, Kalish BT, Cotton BA, et al. Prehospital intravenous fluid administration is associated with higher mortality in trauma patients: a National Trauma Data Bank analysis. Ann Surg. 2011;253(2):371–7.
Ley EJ, Clond MA, Srour MK, et al. Emergency department crystalloid resuscitation of 1.5 L or more is associated with increased mortality in elderly and nonelderly trauma patients. J Trauma. 2011;70(2):398–400.
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. 2014;38:3125–32.
Cobas MA, De la Pena MA, Manning R, et al. Prehospital intubations and mortality: a level 1 trauma center perspective. Anesth Analg. 2009;109(2):489–93.
Albrecht E, Yersin B, Spahn DR, et al. Success rate of airway management by residents in a pre-hospital emergency setting: a retrospective study. Eur J Trauma. 2006;32(6):516–22.
Nakstad AR, Heimdal H, Strand T, et al. Incidence of desaturation during prehospital rapid sequence intubation in a physician-based helicopter emergency service. Am J Emerg Med. 2011;29(6):639–44.
Rognas L, Hansen TM, Kirkegaard H, et al. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scand J Trauma Resusc Emerg Med. 2013;21:58.
Deutsche Gesellschaft für Unfallchirurgie. Whitebook Medical Care of the Severely Injured—second revised and updated edition. Orthop Traumatol Commun News. 2012;Supplement 1:1–63.
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Carsten Schoeneberg, Marc Schilling, Bjoern Hussmann, Daniel Schmitz, Sven Lendemans, and Steffen Ruchholtz declare that they have no conflict of interest.
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This study was approved by the Ethics Committee of the University of Duisburg-Essen, Germany. The use of data from the Trauma Registry of the DGU received the full approval of the Ethics Committee of the University of Witten/Herdecke, Cologne, Germany.
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Schoeneberg, C., Schilling, M., Hussmann, B. et al. Preventable and potentially preventable deaths in severely injured patients: a retrospective analysis including patterns of errors. Eur J Trauma Emerg Surg 43, 481–489 (2017). https://doi.org/10.1007/s00068-016-0670-9
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DOI: https://doi.org/10.1007/s00068-016-0670-9