Problems in Trauma Care and Preventable Deaths

Jung, Koo Young; Kim, Jun Sig; Kim, Yoon

Abstract

PURPOSE: The objectives of this study were (1) to observe the problems in the management of trauma death and to estimate the preventable death rate and (2) to provide guidelines for the analysis of trauma mortality, which is a part of the program to monitor the quality levels of emergency departments(ED).
METHODS
The records of patients who died at the ED or after admission due to trauma at two tertiary and four secondary hospitals between Jan. 1997 and Dec. 1998 were retrospectively reviewed. The medical records of 210 patients were reviewed, and those of 131 patients, i.e., 62.4%, could be used to evaluate preventability.
RESULTS
The preventable death rate was 40.5%, which exceeded the rate of 25% before the implementation of the trauma care system. The preventable death rate of secondary hospitals was 46.5% and that of tertiary hospitals was 28.9%. The number of problems per one death was 5.74, and among them 2.82 problems were related to death. Fifty-two percent of those problems occurred in the ED, 13.9% in the prehospital caie, and 18.9% during transportation between hospitals. When the problems were classified into six categories, treatment problems accounted for 73.4% and system inadequacy for 18.7%. Especially, problems related to resuscitation were 40% of all treatment problems. Delay in transportation or delay in diagnosis also accounted for a significant portion of the problems.
CONCLUSION
The preventable death rate in korea was much higher than the in developed countries, especially for the secondary hospitals. Improving efforts should be focused to the management in the prehospital arena and the ED. Standardization and training for trauma resuscitation still require much effort. The most important thing in a hospital is a trauma care team that can carry out professional treatment promptly.