Ruchholtz S, Nast-Kolb D, Waydhas C, Betz P, Schweiberer L
Chirurgische Klinik und Poliklinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München.
Unfallchirurg. 1994 Jun;97(6):285-91.
In order to assess the impact of errors on outcome and to identify the rate of preventable deaths we investigated 40 premature deaths that had occurred among polytraumatized patients (blunt trauma; average ISS 53 points) in a prospective study (years 1986-1992) in a level I trauma centre. On analysing the patients' course on the basis of a complete set of data we detected 41 management and timing errors, 15 mistakes in treatment and 8 diagnostic problems. According to the significance of the errors the patients could be divided into three groups: in group 1 (n = 12; 30%) no errors were found, in group 2 (n = 22; 45%) there were errors but these definitely had no influence on the outcome, and in group 3 (n = 6;15%) we ascertained errors with a possible influence on the deaths. In none of the 40 cases of premature death could it be definitely shown that the adverse outcome could have been avoided. In the care of polytraumatized patients there was a clear predominance of management and timing errors insofar as they accounted for 64% of all errors that occurred and had frequently preceded possibly preventable deaths (88% in group 3). To diminish sources of error in the management of polytraumatized patients we must demand that more accurate clinical standards and algorithms be developed and introduced into the treatment of such patients.
为了评估失误对治疗结果的影响并确定可预防死亡的发生率，我们在一所一级创伤中心开展了一项前瞻性研究（1986 - 1992年），调查了40例多发伤患者（钝器伤；平均损伤严重度评分53分）的过早死亡情况。基于完整的数据集分析患者的病程，我们发现了41处管理和时机选择失误、15处治疗失误以及8处诊断问题。根据失误的严重程度，患者可分为三组：第1组（n = 12；30%）未发现失误；第2组（n = 22；45%）存在失误，但这些失误肯定对结果没有影响；第3组（n = 6；15%）我们确定存在可能影响死亡的失误。在40例过早死亡病例中，没有一例能明确表明不良后果本可避免。在多发伤患者的护理中，管理和时机选择失误明显占主导，因为它们占所有发生失误的64%，且常常先于可能可预防的死亡出现（第3组中占88%）。为减少多发伤患者管理中的失误来源，我们必须要求制定更精确的临床标准和算法，并将其引入此类患者的治疗中。
