Trauma deaths in an Italian urban area: an audit of pre-hospital and in-hospital trauma care.
In Italy, a comprehensive regional study of trauma deaths has never been performed. We examined the organization and delivery of trauma care in the city area of Milan, using panel review of trauma deaths. Two panels evaluated the appropriateness of care of all trauma victims occurred during 1 year, applying predefined criteria and judging deaths as not preventable (NP), possible preventable (PP), and definitely preventable (DP). Two hundred and fifty-five deaths were reviewed. Blunt trauma were 78.04% and motor vehicle crashes accounted for over 50%. Most victims (73.72%) died during pre-hospital settings and 91.1% died within the first 6h, principally because of central nervous system injuries in blunt and hemorrhage in penetrating trauma. Panels judged 57% of deaths NP, 32% PP, 11% DP (inter-panel K-test 0.88). Preventable deaths were higher after in-hospital admission. Main failures of treatment were lack in airway control or intravenous infusions in pre-hospital and mismanagement with missed injuries in emergency department. The high rate of avoidable deaths in Milan supports the need of trained pre-hospital personnel and of well equipped referring hospitals for trauma.
Istituto di Chirurgia d'Urgenza, Università degli Studi di Milano-IRCCS Ospedale, Maggiore, via Francesco Sforza 35, 20122, Milan, Italy. ochiara@yahoo.com
Osvaldo
O
Chiara
Jane D
JD
Scott
Stefania
S
Cimbanassi
Aldo
A
Marini
Riccardo
R
Zoia
Aurelio
A
Rodriguez
Thomas
T
Scalea
D000059:Accidents / Q000401:mortality*; D000063:Accidents, Traffic / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000368:Aged; D002490:Central Nervous System / Q000293:injuries; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006760:Hospitalization; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D012137:Respiratory System / Q000293:injuries; D013997:Time Factors; D017211:Treatment Failure; D014504:Urban Health / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000401:mortality*