Esposito T J, Sanddal N D, Hansen J D, Reynolds S
Burn and Shock Trauma Institute, Loyola University, Maywood, Illinois 60153, USA.
J Trauma. 1995 Nov;39(5):955-62. doi: 10.1097/00005373-199511000-00022.
The goal of this study was to determine the rate of preventable mortality and inappropriate care in cases of traumatic death occurring in a rural state.
This is a retrospective case review.
Deaths attributed to mechanical trauma throughout the state and occurring between October 1, 1990 and September 30, 1991 were examined. All cases meeting inclusion criteria were reviewed by a multidisciplinary panel of physicians and nonphysicians representing the prehospital as well as hospital phases of care. Deaths were judged frankly preventable, possibly preventable, or nonpreventable. The care rendered in both preventable and nonpreventable cases was evaluated for appropriateness according to nationally accepted guidelines.
The overall preventable death rate was 13%. Among those patients treated at a hospital, the preventable death rate was 27%. The rate of inappropriate care was 33% overall and 60% in-hospital. The majority of inappropriate care occurred in the emergency department phase and was rendered by one or more members of the resuscitation team, including primary contact physicians and surgeons. Deficiencies were predominantly related to the management of the airway and chest injuries.
The rural preventable death rate from trauma is not dissimilar to that found in urban areas before the implementation of a trauma care system. Inappropriate care rendered in the emergency department related to airway and chest injury management occurs at a high rate. This seems to be the major contributor to preventable trauma deaths in rural locations. Education of emergency department primary care providers in basic principles of stabilization and initial treatment may be the most cost-effective method of reducing preventable deaths in the rural setting.
本研究的目的是确定在一个农村州发生的创伤性死亡病例中可预防死亡率和不适当治疗的发生率。
这是一项回顾性病例审查。
对1990年10月1日至1991年9月30日期间该州归因于机械性创伤的死亡病例进行检查。所有符合纳入标准的病例均由一个多学科医生和非医生小组进行审查，该小组代表院前和医院护理阶段。死亡被判定为完全可预防、可能可预防或不可预防。根据国家公认的指南，对可预防和不可预防病例中的治疗进行适当性评估。
总体可预防死亡率为13%。在那些在医院接受治疗的患者中，可预防死亡率为27%。总体不适当治疗发生率为33%，住院时为60%。大多数不适当治疗发生在急诊科阶段，由复苏团队的一名或多名成员提供，包括初级接触医生和外科医生。缺陷主要与气道和胸部损伤的管理有关。
农村创伤可预防死亡率与创伤护理系统实施前城市地区的死亡率没有差异。急诊科在气道和胸部损伤管理方面的不适当治疗发生率很高。这似乎是农村地区可预防创伤死亡的主要原因。对急诊科初级护理提供者进行稳定和初始治疗基本原则的教育可能是降低农村地区可预防死亡的最具成本效益的方法。
