Examining potentially preventable mortality in trauma: What can we do better?

BACKGROUND

Trauma systems have undergone substantial evolution over the past several decades. However, we have yet to achieve the National Academies of Sciences, Engineering, and Medicine goal of zero preventable deaths from injury. In this study, we examined preventable deaths within advanced trauma systems to identify opportunities for further improvement.

METHODS

Task Order One, coordinated within the Linking Investigators in Trauma and Emergency Medical Services Network (LiTES) that included over 30 emergency medical service (EMS) agencies transporting to eight level 1 trauma centers in the United States, created an extensive database of severely injured trauma patients. A potentially preventable mortality (PPM) program was developed. Cause of death was reported by study site primary investigators (PIs), cases were selected for review by a prespecified list of prehospital patient/injury characteristics and cause of death. Reports were generated by the data coordination center and reviewed by the LiTES Executive Operating Committee and the site PI.

RESULTS

Of 2,618 deaths, 391 were reviewed based on established criteria. Of these, 99 (25.3%) were determined to be PPM. For reviewed cases, presenting physiology was similar between PPM and non-PPM patients. Higher proportions of PPM compared with non-PPM were seen in patients who were male, black or African American, with a mechanism of firearm injury or other penetrating injury. The most common cause of PPM was uncontrolled hemorrhage (53%) followed by multiple organ failure (19%), ARDS/primary respiratory failure (9.1%), and coagulopathy (6.1%). Deaths due to uncontrolled hemorrhage and coagulopathy occurred earliest during care.

CONCLUSIONS

In this study, we found that approximately one of our reviewed deaths from injury was potentially preventable. Patients who were male, Black or African American, or sustained firearm or other penetrating injuries were at the highest risk for PPM. On the basis of these data, improvements in hemorrhage management, particularly for firearm and other penetrating injuries, are needed.

LEVEL OF EVIDENCE: Level III, sub-analysis of prospective observational study.