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Analysis of Preventable Trauma Deaths and Opportunities for Trauma Care Improvement in Utah

Sanddal, Teri L. REMT-B, BS; Esposito, Thomas J. MD, MPH; Whitney, Jolene R. MPA; Hartford, Diane MS; Taillac, Peter P. MD, FACEP; Mann, N. Clay PhD, MS; Sanddal, Nels D. REMT-B, CMO, PhDc, MS

Journal of Trauma and Acute Care Surgery: April 2011 - Volume 70 - Issue 4 - p 970-977
doi: 10.1097/TA.0b013e3181fec9ba
Original Article

Background: The objective is to determine the rate of preventable mortality and the volume and nature of opportunities for improvement (OFI) in care for cases of traumatic death occurring in the state of Utah.

Methods: A retrospective case review of deaths attributed to mechanical trauma throughout the state occurring between January 1, 2005, and December 31, 2005, was conducted. Cases were reviewed by a multidisciplinary panel of physicians and nonphysicians representing the prehospital and hospital phases of care. Deaths were judged frankly preventable, possibly preventable, or nonpreventable. The care rendered in both preventable and nonpreventable cases was evaluated for OFI according to nationally accepted guidelines.

Results: The overall preventable death rate (frankly and possibly preventable) was 7%. Among those patients surviving to be treated at a hospital, the preventable death rate was 11%. OFIs in care were identified in 76% of all cases; this cumulative proportion includes 51% of prehospital contacts, 67% of those treated in the emergency department (ED), and 40% of those treated post-ED (operating room, intensive care unit, and floor). Issues with care were predominantly related to management of the airway, fluid resuscitation, and chest injury diagnosis and management.

Conclusions: The preventable death rate from trauma demonstrated in Utah is similar to that found in other settings where the trauma system is under development but has not reached full maturity. OFIs predominantly exist in the ED and relate to airway management, fluid resuscitation, and chest injury management. Resource organization and education of ED primary care providers in basic principles of stabilization and initial treatment may be the most cost-effective method of reducing preventable deaths in this mixed urban and rural setting. Similar opportunities exist in the prehospital and post-ED phases of care.

From the Critical Illness and Trauma Foundation (T.L.S., N.D.S.), Bozeman, Montana; Loyola University Burn & Shock Trauma Institute (T.J.E.), Maywood, Illinois; Utah Department of Health (J.R.W., D.H. P.P.T.), Salt Lake City, Utah; and Intermountain Injury Control Research Center (N.C.M.), Unversity of Utah School of Medicine, Salt Lake City Utah.

Submitted for publication December 4, 2009.

Accepted for publication September 27, 2010.

Supported by Rural Hospital Flexibility Grant Program through HRSA Grant CFDA# 93.241.

The contents of this report are solely the responsibility of the authors and do not necessarily represent the official views of the Utah Department of Health.

Address for reprints: Teri L. Sanddall, Critical illness and Trauma Foundation, 2135 Charlotte St., Suite 2, Bozeman, MT 59718; email:

© 2011 Lippincott Williams & Wilkins, Inc.