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Are Pre-hospital Trauma Deaths Preventable? A Systematic Literature Review

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Abstract

Background

The first and largest peak of trauma mortality is encountered on the trauma site. The aim of this study was to determine whether these trauma-related deaths are preventable. We performed a systematic literature review with a focus on pre-hospital preventable deaths in severely injured patients and their causes.

Methods

Studies published in a peer-reviewed journal between January 1, 1990 and January 10, 2018 were included. Parameters of interest: country of publication, number of patients included, preventable death rate (PP = potentially preventable and DP = definitely preventable), inclusion criteria within studies (pre-hospital only, pre-hospital and hospital deaths), definition of preventability used in each study, type of trauma (blunt versus penetrating), study design (prospective versus retrospective) and causes for preventability mentioned within the study.

Results

After a systematic literature search, 19 papers (total 7235 death) were included in this literature review. The majority (63.1%) of studies used autopsies combined with an expert panel to assess the preventability of death in the patients. Pre-hospital death rates range from 14.6 to 47.6%, in which 4.9–11.3% were definitely preventable and 25.8–42.7% were potentially preventable. The most common (27–58%) reason was a delayed treatment of the trauma victims, followed by management (40–60%) and treatment errors (50–76.6%).

Conclusion

According to our systematic review, a relevant amount of the observed mortality was described as preventable due to delays in treatment and management/treatment errors. Standards in the pre-hospital trauma system and management should be discussed in order to find strategies to reduce mortality.

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Authors and Affiliations

  1. Department of Trauma, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland

    Roman Pfeifer, Sascha Halvachizadeh, Kai Sprengel, Kai Oliver Jensen, Michel Teuben, Ladislav Mica, Valentin Neuhaus & Hans-Christoph Pape

  2. Institute of Legal Medicine, Ludwig-Maximillians-Universität (LMU) Munich, Munich, Germany

    Sylvia Schick

Authors
  1. Roman Pfeifer
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  2. Sascha Halvachizadeh
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  3. Sylvia Schick
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  4. Kai Sprengel
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  5. Kai Oliver Jensen
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  6. Michel Teuben
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  9. Hans-Christoph Pape
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Correspondence to Roman Pfeifer.

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This systematic review does not require ethical approval.

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Pfeifer, R., Halvachizadeh, S., Schick, S. et al. Are Pre-hospital Trauma Deaths Preventable? A Systematic Literature Review. World J Surg 43, 2438–2446 (2019). https://doi.org/10.1007/s00268-019-05056-1

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