title: Trauma-related preventable deaths in Berlin 2010: need to change prehospital management strategies and trauma management education.
abstract: BACKGROUND
  Fatal trauma is one of the leading causes of death in Western industrialized countries. The aim of the present study was to determine the preventability of traumatic deaths, analyze the medical measures related to preventable deaths, detect management failures, and reveal specific injury patterns in order to avoid traumatic deaths in Berlin.
  
  
  METHODS
  In this prospective observational study all autopsied, direct trauma fatalities in Berlin in 2010 were included with systematic data acquisition, including police files, medical records, death certificates, and autopsy records. An interdisciplinary expert board judged the preventability of traumatic death according to the classification of non-preventable (NP), potentially preventable (PP), and definitively preventable (DP) fatalities.
  
  
  RESULTS
  Of the fatalities recorded, 84.9 % (n = 224) were classified as NP, 9.8 % (n = 26) as PP, and 5.3 % (n = 14) as DP. The incidence of severe traumatic brain injury (sTBI) was significantly lower in PP/DP than in NP, and the incidence of fatal exsanguinations was significantly higher. Most PP and NP deaths occurred in the prehospital setting. Notably, no PP or DP was recorded for fatalities treated by a HEMS crew. Causes of DP deaths consisted of tension pneumothorax, unrecognized trauma, exsanguinations, asphyxia, and occult bleeding with a false negative computed tomography scan.
  
  
  CONCLUSIONS
  The trauma mortality in Berlin, compared to worldwide published data, is low. Nevertheless, 15.2 % (n = 40) of traumatic deaths were classified as preventable. Compulsory training in trauma management might further reduce trauma-related mortality. The main focus should remain on prevention programs, as the majority of the fatalities occurred as a result of non-survivable injuries.
authors: Center for Musculoskeletal Surgery, AG Polytrauma, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. christian.kleber@charite.de
authors: C
authors: C
authors: Kleber
authors: M T
authors: MT
authors: Giesecke
authors: M
authors: M
authors: Tsokos
authors: N P
authors: NP
authors: Haas
authors: C T
authors: CT
authors: Buschmann
mesh_terms: D000328:Adult; D000368:Aged; D001604:Berlin / Q000453:epidemiology; D002423:Cause of Death; D004632:Emergency Medical Services / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services; D011446:Prospective Studies; D014194:Traumatology / Q000193:education*; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy