Preventable trauma deaths at the University Hospital of the West Indies - abstract

ABSTRACT

TRISS methodology is a statistical method for detecting unexpected outcome in trauma patients. Unexpected deaths can then be audited to determine the Preventable Trauma Death Rate (PDT), which is a good indicator of the quality of trauma care. This method was utilized to assess trauma care at the University Hospital of the West Indies (UHWI) and to identify areas of treatment failures. All trauma deaths at the UHWI during the calender year 1993 were reviewed. The Probability of Survival (PS) was calculated for each patient, using the Revised Trauma Score and the Injury Severity Score. Unexpected deaths (patients with PS > 0.5) were audited to detect inadequate trauma care. In 40 patients there were 15 unexpected deaths of which 7 were deemed potentially salvageable. Six of these were related to either inadequate resuscitation or delayed surgical intervention. The other was due to surgical inexperience. This represents a PTD rate of 22.5 percent which is similar to that in North America more than a decade ago. Most deaths occurred within the first 12 hours of hospitalization with another peak at approximately 9 days. Improvement in trauma care at UHWI can be achieved by the introduction of relatively cheap countermeasures rather than by acquiring expensive medical equipment. Continuing Medical Education programmes like the Advanced Trauma Life Support course should be introduced and may result in improvement in trauma care similar to that of developed countries (AU)