title: Preventable deaths in trauma patients associated with non adherence to management guidelines.
abstract: OBJECTIVE
  To evaluate patients treated for traumatic injuries and to identify adherence to guidelines recommendations of treatment and association with death. The recommendations adopted were defined by the committee on trauma of the American College of Surgeons in advanced trauma life support.
  
  
  METHODS
  Retrospective cohort study conducted at a teaching hospital. The study population was victims of trauma > 12 years of age with injury severity scores > 16 who were treated between January 1997 and December 2001. Data collection was divided into three phases: pre-hospital, in-hospital, and post-mortem. The data collected were analyzed using EPI INFO.
  
  
  RESULTS
  We analyzed 207 patients, 147 blunt trauma victims (71%) and 60 (29%) penetrating trauma victims. Trauma victims had a 40.1% mortality rate. We identified 221 non adherence events that occurred in 137 patients. We found a mean of 1.61 non adherence per patient, and it occurred less frequently in survivors (1.4) than in non-survivors (1.9; p=0.033). According to the trauma score and injury severity score methodology, 54.2% of deaths were considered potentially preventable. Non adherence occurred 1.77 times more frequently in those considered potentially preventable deaths compared to other non-survivors (95% CI: 1.12-2.77; p=0.012), and 92.9% of the multiple non adherence occurred in the first group (p=0.029).
  
  
  CONCLUSIONS
  Non adherence occurred more frequently in patients with potentially preventable deaths. Non adherence to guidelines recommendations can be considered a contributing factor to death in trauma victims and can lead to an increase in the number of potentially preventable deaths.
authors.affiliation: Departamento de Clínica Cirúrgica, Universidade Estadual de Londrina, Londrina, PR, Brasil.
authors.forename: Antonio Cesar
authors.initials: AC
authors.lastname: Marson
authors.affiliation: Departamento de Clínica Médica, Universidade Estadual de Londrina, Londrina, PR, Brasil.
authors.forename: Cintia Magalhães Carvalho
authors.initials: CM
authors.lastname: Grion
authors.affiliation: Departamento de Clínica Médica, Universidade Estadual de Londrina, Londrina, PR, Brasil.
authors.forename: Olavo Franco
authors.initials: OF
authors.lastname: Ferreira Filho
authors.affiliation: Departamento de Clínica Cirúrgica, Universidade Estadual de Londrina, Londrina, PR, Brasil.
authors.forename: João Carlos
authors.initials: JC
authors.lastname: Thomson