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

European Journal of Trauma and Emergency Surgery (2022)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Funding

This study did not receive any financial assistance.

Author information

Authors and Affiliations

  1. Anaesthesiology and Intensive Care Department, Military Teaching Hospital Sainte Anne, Toulon, France

    Sarah Guigues, Jean Cotte, Eric Meaudre, Julien Bordes & Michael Cardinale

  2. Surgery Department, Military Teaching Hospital Sainte Anne, Toulon, France

    Jean-Baptiste Morvan & Henry de Lesquen

  3. Anaesthesiology and Intensive Care Department, Laveran Military Teaching Hospital, Marseille, France

    Bertrand Prunet

  4. Anaesthesiology and Intensive Care Department, Percy Military Teaching Hospital, Paris, France

    Mathieu Boutonnet, Nicolas Libert & Pierre Pasquier

  5. French Special Operations Forces Medical Component Command, Villacoublay, France

    Pierre Pasquier

  6. Ecole du Val de Grâce, French Military Medical Academy, Paris, France

    Bertrand Prunet, Mathieu Boutonnet, Nicolas Libert, Pierre Pasquier, Eric Meaudre & Julien Bordes

  7. Fédération d’Anesthésie–Réanimation, Hôpital d’Instruction des Armées Sainte-Anne, Boulevard Sainte-Anne, BP 20545-83041, Toulon Cedex 9, France

    Michael Cardinale

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  1. Sarah Guigues
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Contributions

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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Conflict of interest

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). https://doi.org/10.1007/s00068-022-02194-5

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  • DOI: https://doi.org/10.1007/s00068-022-02194-5

Keywords

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