title: Patterns of early mortality after trauma in a neighborhood urban trauma center: can we improve outcomes?
abstract: Even with specialized trauma systems, a significant number of deaths occur within the early postinjury period. Our goal was to examine deaths within this period for cause and determine if care could improve outcomes. A retrospective chart review was performed on all patients who were dead on arrival or died within 4 hours of arrival between January 1, 2005, and December 31, 2011. Survival probabilities and Injury Severity Score (ISS) were calculated. Chart review and trauma review processes were used to determine cases with opportunities for care improvement. Two hundred eighty-nine patients were dead on arrival (DOA), and 176 patients died within 4 hours of arrival. The most common mechanism of injury was gunshot wounds (68.4%). The most common causes of death were uncontrolled hemorrhage (68.2%) and neurologic trauma (23.4%). Average ISS was 32. Twenty-nine patients had survival probability percentages over 50. Ten of 176 (5.7%) deaths were found to have opportunities for care improvement. In three cases (1.7%), errors contributed to death. The majority of trauma patients DOA or dying within 4 hours of hospital arrival have nonsurvivable injuries. Regular trauma review processes are invaluable in determining opportunities for care improvement. Autopsy information increases the reliability of the review process.
authors.affiliation: Department of Trauma Surgery, Sinai Grace Hospital, Detroit Medical Center, Detroit, Michigan, USA. berbigli@gmail.com
authors.forename: Lindsay
authors.initials: L
authors.lastname: Berbiglia
authors.forename: Peter P
authors.initials: PP
authors.lastname: Lopez
authors.forename: Leah
authors.initials: L
authors.lastname: Bair
authors.forename: Adelaide
authors.initials: A
authors.lastname: Ammon
authors.forename: Gwyneth
authors.initials: G
authors.lastname: Navas
authors.forename: Melissa
authors.initials: M
authors.lastname: Keller
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Diebel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006786:Hospitals, Urban / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data; D008824:Michigan; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D012189:Retrospective Studies; D016019:Survival Analysis; D014193:Trauma Centers / Q000592:standards* / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D055815:Young Adult