Maio R F, Burney R E, Gregor M A, Baranski M G
Section of Emergency Medicine, University of Michigan Medical Center, Ann Arbor 48109-0303, USA.
J Trauma. 1996 Jul;41(1):83-90. doi: 10.1097/00005373-199607000-00013.
To determine the preventable death rate (PDR) and the frequency and types of inappropriate medical care in a large, rural region of Michigan.
A prospective study of all deaths caused by injury during a 1-year period.
Preventability of death and appropriateness of care were determined using a structured implicit review process and expert panel. A second panel was convened to confirm the reliability of the review process.
One hundred fifty-five injury-related deaths underwent panel review. Four deaths (2.6%) were found to be definitely preventable and 16 (10.3%) possibly preventable, for a combined preventable death rate of 12.9%. Sixty-five deaths (41.9%) occurred in the emergency department or hospital; 18 of these (27.7%) were judged to be definitely preventable or possibly preventable. Forty-three episodes of inappropriate care were identified in 27 (17.4%) of the 155 cases reviewed. These occurred primarily in the emergency department and hospital rather than during prehospital care or transfer.
A relatively small percentage of trauma fatalities in rural Michigan could have been prevented by more appropriate or timely medical care. Efforts to improve the care of injured persons in rural Michigan should be directed primarily at the emergency department and inpatient phases of trauma system care.
确定密歇根州一个大型农村地区的可预防死亡率（PDR）以及不恰当医疗护理的频率和类型。
对1年内所有因伤致死情况进行前瞻性研究。
采用结构化隐性审查流程和专家小组来确定死亡的可预防性和护理的恰当性。召集第二个小组以确认审查流程的可靠性。
155例与损伤相关的死亡病例接受了小组审查。发现4例死亡（2.6%）肯定可预防，16例（10.3%）可能可预防，综合可预防死亡率为12.9%。65例死亡（41.9%）发生在急诊科或医院；其中18例（27.7%）被判定为肯定可预防或可能可预防。在155例审查病例中的27例（17.4%）中识别出43起不恰当护理事件。这些事件主要发生在急诊科和医院，而非院前护理或转运期间。
密歇根州农村地区相对较小比例的创伤死亡本可通过更恰当或更及时的医疗护理得以预防。改善密歇根州农村地区受伤人员护理的努力应主要针对创伤系统护理的急诊科和住院阶段。
