Preventable morbidity at a mature trauma center.
OBJECTIVE
To analyze the preventable and potentially preventable complications occurring at a mature level I trauma center.


METHODS
Retrospective review.


METHODS
Academic level I trauma center.


METHODS
The study included 35 311 trauma registry patients.


METHODS
The cause, effect on outcome, preventability (preventable, potentially preventable, or nonpreventable), and loop closure recommendations for all preventable and potentially preventable complications, and clinical data related to each complication retrieved from the trauma registry and individual medical records.


RESULTS
Over the 8-year study, 35 311 trauma registry patients experienced 2560 complications. Three hundred fifty-one patients (0.99% of all patients) had 403 preventable or potentially preventable complications. The most common preventable or potentially preventable complications were unintended extubation (63 patients [17% of complications]), surgical technical failures (61 patients [15% of complications]), missed injuries (58 patients [14% of complications]), and intravascular catheter-related complications (48 patients [12% of complications]). These complications were clinically relevant; 258 (64% of complications) resulted in a change in management, including 61 laparotomies, 52 reintubations, 41 chest tube insertions, and 19 vascular interventions.


CONCLUSIONS
The incidence of preventable or potentially preventable complications at an academic level I trauma center is low. These complications often require a change in management and cluster in 4 major categories (ie, unintended extubation, surgical technical failures, missed injuries, and intravascular catheter-related complications) that must be recognized as critical areas for quality improvement initiatives.
Teixeira
Pedro G R
PG
Division of Trauma Surgery and Surgical Critical Care, University of Southern California, Los Angeles, CA 90033, USA.
Inaba
Kenji
K
Salim
Ali
A
Rhee
Peter
P
Brown
Carlos
C
Browder
Timothy
T
DuBose
Joseph
J
Nomoto
Shirley
S
Demetriades
Demetrios
D
D000293:Adolescent; D000328:Adult; D002140:California / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D014193:Trauma Centers / Q000592:standards*; D014194:Traumatology; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality*; D055815:Young Adult