Eyi Yusuf Emrah, Toygar Mehmet, Karbeyaz Kenan, Kaldırım Ümit, Tuncer Salim Kemal, Durusu Murat
Department of Emergency Medicine, Gülhane Military Medical Academy, Ankara, Turkey.
Department of Forensic Medicine, Gulhane Military Medical Academy, Ankara, Turkey.
Ulus Travma Acil Cerrahi Derg. 2015 Mar;21(2):127-33. doi: 10.5505/tjtes.2015.94658.
The analysis of autopsy reports plays an important role in the evaluation of trauma care quality. The objective of this study was to determine the rate of preventable deaths and medical errors in regard to the autopsy reports as an indicator of trauma care quality in traumatic deaths.
A retrospective review of traumatic autopsy reports kept between 2011 and 2012 in Eskişehir, Turkey was conducted. Demographic data of the cases, injury type, injury mechanism, injury location, ISS values, and cause and place of death were recorded. Deaths were judged in three groups including preventable deaths, potentially preventable deaths and non-preventable deaths. In the definiton of preventability, the criteria of American College of Surgeons Committee on Trauma were used. A commission composed of two forensic medicine specialists and one emergency medicine specialist reviewed preventability and defined medical errors.
A total of five hundred and ninety-two autopsy reports were examined in the study period. Trauma was defined as the cause in 65.2% (n=386) of the cases. 81.9% (n=316) of the cases were observed to have suffered blunt injury and 18.1% (n=70) penetrating injury. Death occurred at the scene of trauma in 56.7% (n=219) of the cases, in the pre-hospital period in 11.7% (n=45), and in hospital in 31.6% (n=122). In preventability analysis, it was decided that 4.1% (n=16) of the cases had the properties of being preventable, 14.5% (n=56) potentially preventable and 81.3% (n=314) non-preventable. Suboptimal care was determined in 65.3% (n=47) of the total cases, delayed intervention in 58.3% (n=42), error in the medical method decision in 8.3% (n=6), delayed or wrong diagnosis in 1.4% (n=1), and inappropriate or incorrect medical application in 1.4% (n=1).
High rates of preventable deaths in the pre-hospital period, in cases of penetrating injuries, and particularly in cases of chest trauma were evaluated as noteworthy findings. Integrated working of pre-hospital emergency healthcare services with trauma centres would enable the development of trauma care and reduce the rates of preventable deaths.
尸检报告分析在创伤护理质量评估中发挥着重要作用。本研究的目的是确定可预防死亡和医疗差错的发生率，将尸检报告作为创伤性死亡中创伤护理质量的一个指标。
对2011年至2012年保存在土耳其埃斯基谢希尔的创伤尸检报告进行回顾性研究。记录病例的人口统计学数据、损伤类型、损伤机制、损伤部位、损伤严重度评分（ISS）值以及死亡原因和地点。死亡分为三组，包括可预防死亡、潜在可预防死亡和不可预防死亡。在可预防性的定义中，采用了美国外科医师学会创伤委员会的标准。一个由两名法医学专家和一名急诊医学专家组成的委员会审查可预防性并界定医疗差错。
在研究期间共检查了592份尸检报告。65.2%（n = 386）的病例将创伤定义为死因。81.9%（n = 316）的病例为钝器伤，18.1%（n = 70）为穿透伤。56.7%（n = 219）的病例在创伤现场死亡，11.7%（n = 45）在院前死亡，31.6%（n = 122）在医院死亡。在可预防性分析中，确定4.1%（n = 16）的病例具有可预防的特征，14.5%（n = 56）为潜在可预防，81.3%（n = 314）为不可预防。在所有病例中，65.3%（n = 47）存在护理欠佳，58.3%（n = 42）存在干预延迟，8.3%（n = 6）存在医疗方法决策错误，1.4%（n = 1）存在诊断延迟或错误，1.4%（n = 1）存在医疗应用不当或错误。
院前、穿透伤尤其是胸部创伤病例中可预防死亡的高发生率被视为值得关注的发现。院前紧急医疗服务与创伤中心的联合工作将有助于创伤护理的发展并降低可预防死亡的发生率。
