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Analysis of mortality over 7 years in a mature trauma center: evolution of preventable mortality in severe trauma patients



The study of preventable trauma deaths is one mechanism used to examine the quality of care and outcomes of a trauma system. The present study aims to define the rate of preventable (PD) and potentially preventable death (PPD) in our mature trauma center, determine its leading causes, and evaluate the evolution of this rate over the years.


We performed a retrospective observational study in the Sainte Anne Military Teaching Hospital, Toulon (Var), France. From January 2013 to December 2020, all patients with severe trauma admitted to our trauma center and who died were analyzed. An independent group of 4 experts in the management of severe trauma performed the classification of deaths using a DELPHI method.


During the study period, 180 deaths occurred among 2642 consecutive severe trauma patients (overall mortality 6.8%). 169 deaths were analyzed, Eleven (6.5%) were considered PD, and thirty-eight (22.1%) were PPD. 69 errors were identified. The most frequent errors were in pre-hospital (excessive pre-hospital times 33.3% and inadequate management 29%). Time before surgery was considered excessive in 15.9% of cases. Over the study period, the rates of PD and PPD deaths remained stable.


PD and PPD rates are still high and do not decrease over the years in our mature trauma center. It confirms the need for progress in the management of severe trauma patients. Reducing the time to provide care seems to be the main area for improvement. Further studies will be necessary to better target the points to be improved.

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Fig. 1

Data availability statement

The authors declare that the data are kept by the HIA Sainte Anne and are available on request.


  1. Teixeira PGR, Inaba K, Hadjizacharia P, Brown C, Salim A, Rhee P, et al. Preventable or potentially preventable mortality at a mature trauma center. J Trauma. 2007;63:1338–46 (discussion1346–7).

    Google Scholar 

  2. Cameron PA, Gabbe BJ, Cooper DJ, Walker T, Judson R, McNeil J. A statewide system of trauma care in Victoria: effect on patient survival. Med J Aust. 2008;189:546–50.

    Article  Google Scholar 

  3. Gabbe BJ, Simpson PM, Sutherland AM, Dip G, Wolfe R, Fitzgerald MC, et al. Improved functional outcomes for major trauma patients in a regionalized. Inclusive Trauma System Ann Surg. 2012;255(6):1009–15.

    Google Scholar 

  4. MacKenzie EJ, Rivara FP, Of GJEJ. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–78.

    Article  CAS  Google Scholar 

  5. Nathens AB, Jurkovich GJ, Cummings P, Rivara FP, Maier RV. The effect of organized systems of trauma care on motor vehicle crash mortality. JAMA Am Med Assoc. 2000;283:1990–4.

    Article  CAS  Google Scholar 

  6. Davis JS, Satahoo SS, Butler FK, Dermer H, Naranjo D, Julien K, et al. An analysis of prehospital deaths: who can we save? J Trauma Acute Care Surg. 2014;77:213–8.

    Article  Google Scholar 

  7. Drake SA, Holcomb JB, Yang Y, Thetford C, Myers L, Brock M, et al. Establishing a regional trauma preventable/potentially preventable death rate. Ann Surg. 2020;271:375–82.

    Article  Google Scholar 

  8. Hospital and pre-hospital resources for optimal care of the injured patient. Committee on Trauma, American College of Surgeons. Bull Am Coll Surg. 1986;71(10):4–23.

  9. Shafi S, Friese R, Gentilello LM. Moving beyond personnel and process: a case for incorporating outcome measures in the trauma center designation process. Arch Surg. 2008;143(2):115–9 (discussion 120).

    Article  Google Scholar 

  10. Detmer DE, Moylan JA, Rose J, Schulz R, Wallace R, Daly R. Regional categorisation and quality of care in major trauma. J Trauma août. 1977;17(8):592–9.

    Article  CAS  Google Scholar 

  11. Moylan JA, Detmer DE, Rose J, Schulz R. Evaluation of the quality of hospital care for major trauma. J Trauma juill. 1976;16(7):517–23.

    CAS  Google Scholar 

  12. West JG, Cales RH, Gazzaniga AB. Impact of regionalization: the orange county experience. Arch Surg. 1983;118(6):740–4.

    Article  CAS  Google Scholar 

  13. Beck B, Smith K, Mercier E, Cameron P. Clinical review of prehospital trauma deaths—the missing piece of the puzzle. Injury. 2017;48(5):971–2.

    Article  Google Scholar 

  14. ATLS Subcommittee, American College of Surgeons’ Committee on Trauma, International ATLS working group. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363–6.

  15. Schluter PJ, Nathens A, Neal ML, Goble S, Cameron CM, Davey TM, et al. Trauma and injury severity score (TRISS) coefficients 2009 revision. J Trauma. 2010;68:761–70.

    Google Scholar 

  16. Sartorius D, Le Manach Y, David J-S, Rancurel E, Smail N, Thicoïpé M, et al. Mechanism, Glasgow coma scale, age, and arterial pressure (MGAP): a new simple prehospital triage score to predict mortality in trauma patients. Crit Care Med. 2010;38(3):831–7.

    Article  Google Scholar 

  17. Teixeira PGR, Inaba K, Salim A, Rhee P, Brown C, Browder T, et al. Preventable morbidity at a mature trauma center. Arch Surg. 2009;144(6):536–41 (discussion 541-2).

    Article  Google Scholar 

  18. Bouzat P, Raux M, David J-S, Tazarourte K, Galinski M, Desmettre T, et al. Chest trauma: first 48hours management. Anaesth Crit Care Pain Med. 2017;36(2):135–45.

    Article  Google Scholar 

  19. Thompson L, Hill M, Lecky F, Shaw G. Defining major trauma: a Delphi study. Scand J Trauma Resusc Emerg Med BioMed Central. 2021;29:63–20.

    Article  Google Scholar 

  20. Cayten CG, Stahl WM, Agarwal N, Murphy JG. Analyses of preventable deaths by mechanism of injury among 13,500 trauma admissions. Ann Surg. 1991;214:510–20 (discussion 520–1).

    Article  CAS  Google Scholar 

  21. Girard E, Jegousso Q, Boussat B, François P, Ageron FX, Letoublon C, et al. Preventable deaths in a French regional trauma system: a six-year analysis of severe trauma mortality. J Visc Surg. 2019;156(1):10–6.

    Article  CAS  Google Scholar 

  22. Sanddal TL, Esposito TJ, Whitney JR, Hartford D, Taillac PP, Mann NC, et al. Analysis of preventable trauma deaths and opportunities for trauma care improvement in utah. J Trauma. 2011;70:970–7.

    Google Scholar 

  23. MacKenzie EJ. Review of evidence regarding trauma system effectiveness resulting from panel studies. J Trauma. 1999;47:S34-41.

    Article  CAS  Google Scholar 

  24. West JG. Validation of autopsy method for evaluating trauma care. Arch Surg Am. 1982;117(8):1033–5.

    Article  CAS  Google Scholar 

  25. Chiara O, Cimbanassi S, Pitidis A, Vesconi S. Preventable trauma deaths: from panel review to population based-studies. World J Emerg Surg. 2006;1:12.

    Article  Google Scholar 

  26. Janak JC, Sosnov JA, Bares JM, Stockinger ZT, Montgomery HR, Kotwal RS, et al. Comparison of military and civilian methods for determining potentially preventable deaths: a systematic review. JAMA Surg. 2018;153:367–75.

    Article  Google Scholar 

  27. Dutton RP, Stansbury LG, Leone S, Kramer E, Hess JR, Scalea TM. Trauma mortality in mature trauma systems: are we doing better? An analysis of trauma mortality patterns, 1997–2008. J Trauma. 2010;69(3):620–6.

    Google Scholar 

  28. Park Y, Lee GJ, Lee MA, Choi KK, Gwak J, Hyun SY, et al. Major causes of preventable death in trauma patients. J Trauma Inj. 2021;34(4):225–32.

    Article  Google Scholar 

  29. Oyeniyi BT, Fox EE, Scerbo M, Tomasek JS, Wade CE, Holcomb JB. Trends in 1029 trauma deaths at a level 1 trauma center: impact of a bleeding control bundle of care. Injury. 2017;48(1):5–12.

    Article  Google Scholar 

  30. Harmsen AMK, Giannakopoulos GF, Moerbeek PR, Jansma EP, Bonjer HJ, Bloemers FW. The influence of prehospital time on trauma patients outcome: a systematic review. Injury. 2015;46(4):602–9.

    Article  CAS  Google Scholar 

  31. Härtl R, Gerber LM, Iacono L, Ni Q, Lyons K, Ghajar J. Direct Transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury. J Trauma. 2006;60(6):1250–6 (discussion 1256).

    Article  Google Scholar 

  32. Kinoshita T, Yamakawa K, Matsuda H, Yoshikawa Y, Wada D, Hamasaki T, et al. The survival benefit of a novel trauma workflow that includes immediate whole-body computed tomography, surgery, and interventional radiology, all in one trauma resuscitation room: a retrospective historical control study. Ann Surg. 2019;269:370–6.

    Article  Google Scholar 

  33. Umemura Y, Watanabe A, Kinoshita T, Morita N, Yamakawa K, Fujimi S. Hybrid emergency room shows maximum effect on trauma resuscitation when used in patients with higher severity. J Trauma Acute Care Surg. 2021;90:232–9.

    Article  Google Scholar 

  34. Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, et al. The STOP the bleeding campaign. Crit Care. 2013;17(2):136.

    Article  Google Scholar 

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This study did not receive any financial assistance.

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Authors and Affiliations



MC, JB, JC and SG design the study. MC is its guarantor. BP, MB, NL and PP were the independent experts and performed the data analysis. MC and J-BM were the two other experts. MC and SG, established and managed the statistical analysis. All the authors have contributed to writing the manuscript and approving the final manuscript.

Corresponding author

Correspondence to Michael Cardinale.

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The authors declare that they have no competing interests. The publication has not been published elsewhere.

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Guigues, S., Cotte, J., Morvan, JB. et al. Analysis of mortality over 7 years in a mature trauma center: evolution of preventable mortality in severe trauma patients. Eur J Trauma Emerg Surg (2022).

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  • Trauma center
  • Trauma system
  • Preventable death
  • Preventable errors