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Preventable Trauma Deaths and Corrective Actions to Prevent Them: A 10-Year Comparative Study at the Komfo Anokye Teaching Hospital, Kumasi, Ghana

World Journal of Surgery volume 44, pages 3643–3650 (2020)Cite this article

Abstract

Objective

To determine the rate of preventable trauma deaths in an African hospital, identify the potential effect of improvements in trauma care over the past decade and identify deficiencies in care that still need to be addressed.

Methods

A multidisciplinary panel assessed pre-hospital, hospital, and postmortem data on 89 consecutive in-hospital trauma deaths over 5 months in 2017 at the Komfo Anokye Teaching Hospital. The panel judged the preventability of each death. For definitely and potentially preventable deaths, the panel identified deficiencies in care.

Results

Thirteen percent (13%) of trauma deaths were definitely preventable, 47% potentially preventable, and 39% non-preventable. In comparison with a panel review in 2007, there was no change in total preventable deaths, but there had been a modest decrease in definitely preventable deaths (25% in 2007 to 13% in 2017, p = 0.07) There was a notable change in the pattern of deficiency (p = 0.001) with decreases in pre-hospital delay (19% of all trauma deaths in 2007 to 3% in 2017) and inadequate resuscitation (17 to 8%), but an increase in delay in treatment at the hospital (23 to 40%).

Conclusions

Over the past decade, there have been improvements in pre-hospital transport and in-hospital resuscitation. However, the preventable death rate remains unacceptably high and there are still deficiencies to address. This study also demonstrates that preventable death panel reviews are a feasible method of trauma quality improvement in the low- and middle-income country setting.

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References

  1. World Health Organization. Global Health Estimates. https://www.who.int/healthinfo/global_burden_disease/estimates/en/. Accessed May 21, 2020

  2. World Health Organization (2004) Guidelines for essential trauma care. World Health Organization, Geneva

    Google Scholar 

  3. Nathens AB, Jurkovich GJ, Cummings P et al (2000) The effect of organized systems of trauma care on motor vehicle crash mortality. JAMA 283:1990–1994

    CAS  Article  Google Scholar 

  4. Nathens AB, Jurkovich GJ, Rivara FP et al (2000) Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation. J Trauma 48:25–30 Discussion 30–21

    CAS  Article  Google Scholar 

  5. Mann NC, Mullins RJ, MacKenzie EJ et al (1999) Systematic review of published evidence regarding trauma system effectiveness. J Trauma 47:S25–33

    CAS  Article  Google Scholar 

  6. Jurkovich GJ, Mock C (1999) Systematic review of trauma system effectiveness based on registry comparisons. J Trauma 47:S46–55

    CAS  Article  Google Scholar 

  7. American College of Surgeons (2014) CoT, resources for optimal care of the injured 2014. American College of Surgeons, Chicago, p 181

    Google Scholar 

  8. World Health Organization (2009) Guidelines for trauma quality improvement programmes. World Health Organization, Geneva

    Google Scholar 

  9. West JG, Trunkey DD, Lim RC (1979) Systems of trauma care. A study of two counties. Arch Surg 114:455–460

    CAS  Article  Google Scholar 

  10. West JG (1981) An autopsy method for evaluating trauma care. J Trauma 21:32–34

    CAS  Article  Google Scholar 

  11. Esposito TJ, Sanddal TL, Reynolds SA et al (2003) Effect of a voluntary trauma system on preventable death and inappropriate care in a rural state. J Trauma 54:663–669 Discussion 669–670

    Article  Google Scholar 

  12. Cales RH (1984) Trauma mortality in Orange County: the effect of implementation of a regional trauma system. Ann Emerg Med 13:1–10

    CAS  Article  Google Scholar 

  13. Zafarghandi MR, Modaghegh MH, Roudsari BS (2003) Preventable trauma death in Tehran: an estimate of trauma care quality in teaching hospitals. J Trauma 55:459–465

    Article  Google Scholar 

  14. Jat AA, Khan MR, Zafar H et al (2004) Peer review audit of trauma deaths in a developing country. Asian J Surg 27:58–64

    Article  Google Scholar 

  15. Afuwape OO, Okolo CA, Akinyemi OA (2011) Preventable trauma deaths in Ibadan: a comparison of revised trauma score and panel review. West Afr J Med 30:19–23

    CAS  PubMed  Google Scholar 

  16. Yeboah D, Mock C, Karikari P et al (2014) Minimizing preventable trauma deaths in a limited-resource setting: a test-case of a multidisciplinary panel review approach at the Komfo Anokye Teaching Hospital in Ghana. World J Surg 38:1707–1712. https://doi.org/10.1007/s00268-014-2452-z

    Article  PubMed  PubMed Central  Google Scholar 

  17. London JA, Mock CN, Quansah RE et al (2001) Priorities for improving hospital-based trauma care in an African city. J Trauma 51:747–753

    CAS  Article  Google Scholar 

  18. Zakariah A, Stewart BT, Boateng E et al (2017) The birth and growth of the national ambulance service in Ghana. Prehosp Disaster Med 32:83–93

    Article  Google Scholar 

  19. Oteng RA, Osei-Kwame D, Forson-Adae MSE et al (2019) The preventability of trauma-related death at a tertiary hospital in Ghana: a multidisciplinary panel review approach. Afr J Emerg Med 9:202–206

    Article  Google Scholar 

  20. Maio RF, Burney RE, Gregor MA et al (1996) A study of preventable trauma mortality in rural Michigan. J Trauma 41:83–90

    CAS  Article  Google Scholar 

  21. MacKenzie EJ (1999) Review of evidence regarding trauma system effectiveness resulting from panel studies. J Trauma 47:S34–41

    CAS  Article  Google Scholar 

  22. Pfeifer R, Halvachizadeh S, Schick S et al (2019) Are pre-hospital trauma deaths preventable? A systematic literature review. World J Surg 43:2438–2446. https://doi.org/10.1007/s00268-019-05056-1

    Article  PubMed  Google Scholar 

  23. Jung K, Kim I, Park SK et al (2019) Preventable trauma death rate after establishing a national trauma system in Korea. J Korean Med Sci 34:e65

    Article  Google Scholar 

  24. Roy N, Kizhakke Veetil D, Khajanchi MU et al (2017) Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths. BMC Health Serv Res 17:142

    Article  Google Scholar 

  25. Heim C, Cole E, West A et al (2016) Survival prediction algorithms miss significant opportunities for improvement if used for case selection in trauma quality improvement programs. Injury 47:1960–1965

    Article  Google Scholar 

  26. Kwon AM, Garbett NC, Kloecker GH (2014) Pooled preventable death rates in trauma patients : Meta analysis and systematic review since 1990. Eur J Trauma Emerg Surg 40:279–285

    CAS  Article  Google Scholar 

  27. World Health Organization (2010) Strengthening care for the injured: success stories and lessons learned from around the world. WHO, Geneva

    Google Scholar 

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Acknowledgement

This study was funded by grant D43-TW007267 from the Fogarty International Center of the US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding

This study was funded by grant D43-TW007267 from the Fogarty International Center of the US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Author information

Affiliations

  1. Directorate of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Dominic Konadu-Yeboah, Kusi Kwasi & Senyo Gudugbe

  2. Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Peter Donkor, Augustus Okleme & Frank Nketiah Boakye

  3. Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Ossei Sampen

  4. Directorate of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Maxwell Osei-Ampofo

  5. Department of Anaesthesia, Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Helena Okrah

  6. Department of Surgery, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Box 359960, Seattle, WA, 98104, USA

    Charles Mock

Authors
  1. Dominic Konadu-Yeboah
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  2. Kusi Kwasi
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  3. Peter Donkor
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  4. Senyo Gudugbe
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  5. Ossei Sampen
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  6. Augustus Okleme
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  7. Frank Nketiah Boakye
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  8. Maxwell Osei-Ampofo
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  9. Helena Okrah
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  10. Charles Mock
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Corresponding author

Correspondence to Charles Mock.

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Conflict of interest

None declared by any of the authors.

Ethical approval

The study was approved by the Committee for Human Research and Publication Ethics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.

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Konadu-Yeboah, D., Kwasi, K., Donkor, P. et al. Preventable Trauma Deaths and Corrective Actions to Prevent Them: A 10-Year Comparative Study at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. World J Surg 44, 3643–3650 (2020). https://doi.org/10.1007/s00268-020-05683-z

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  • DOI: https://doi.org/10.1007/s00268-020-05683-z