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Management Deficiencies and Death Preventability of Road Traffic Fatalities Before and After a New Trauma Care System in Victoria, Australia

McDermott, Frank T. MD, FRACS, FRCS (Eng), FACS; Cordner, Stephen M. MRCPath, FRCPA, DipCrim, DMJ; Cooper, David J. MD, FRACP, FJFICM; Winship, Victoria C. BSc; the Consultative Committee on Road Traffic Fatalities in Victoria

Journal of Trauma-Injury Infection & Critical Care: August 2007 - Volume 63 - Issue 2 - pp 331-338
doi: 10.1097/TA.0b013e31806dc5c4
Original Articles

Background: The Consultative Committee's findings that preventable or potentially preventable (P/PP) death rates (survival prospects ≥25%) of road crash fatalities who received treatment were unaltered between 1992 and 1998 led to a Ministerial Taskforce on Trauma and the gradual introduction of a new Victorian trauma care system. The present study compares outcomes before (1997–1998) and after (2002–2004) the new system.

Methods: The emergency and clinical management and death preventability of 245 consecutive fatalities in the ‘before’ period and 193 in the ‘after’ period was assessed by the committee's multidisciplinary panels using the complete hospital, ambulance, and autopsy findings.

Results: Emergency department admissions to expanded Major Trauma Services (MTS) increased from 34% to 62% (p < 0.05). More patients were attended by Advanced Trauma Life Support paramedics (p < 0.05) and scene times increased (p < 0.05). Patients admitted within 1 hour decreased from 70% to 45% (p < 0.05). The mean number of deficiencies per patient including those contributing to death was decreased (p < 0.05). The combined P/PP death rates decreased from 36% to 28% (22% relative risk reduction). The P/PP death rates for MTS, Metropolitan Trauma Services, Rural Trauma Services, and Urgent Care Centers for 2002 to 2004 were 25%, 33%, 50%, and 83%, respectively, and did not differ significantly from those of 1997 to 1998 (23%, 49%, 36%, 75%, respectively). The P/PP death rates in MTS were less than those of the other hospital groups.

Conclusions: The new Victorian trauma care system has resulted in a significant decrease in deficiencies including those contributing to death and a decrease in P/PP deaths rates. The improvement has been largely consequent to a marked increase in admissions to MTS.

From the Department of Surgery (F.T.McD.), Austin Health/Northern Health, The University of Melbourne, Heidelberg; Consultative Committee on Road Traffic Fatalities in Victoria (F.T.McD., S.M.C.); Victorian Institute of Forensic Medicine, Department of Forensic Medicine (S.M.C.), Monash University, Melbourne; Head, Trauma Intensive Care (D.J.C.), Alfred Hospital; National Trauma Research Institute (D.J.C.); Departments of Medicine, Surgery, and Epidemiology (D.J.C.), Monash University, Melbourne; and Informatics (V.C.W.), Victorian Institute of Forensic Medicine, Victoria, Australia.

Submitted for publication October 11, 2006.

Accepted for publication April 11, 2007.

Address for reprints: Vicky Winship, Victorian Institute of Forensic Medicine, 57-83 Kavanagh St, Southbank, Victoria, Australia 3006; email: vicky@vifm.org.

© 2007 Lippincott Williams & Wilkins, Inc.