[Early mortality in polytrauma. A critical analysis of preventable errors].
[Early mortality in polytrauma. A critical analysis of preventable errors].
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[多发伤的早期死亡率。
DOI：
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发表时间：
1994
期刊：
影响因子：
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通讯作者：
L. Schweiberer
中科院分区：
文献类型：
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作者：
S. Ruchholtz;D. Nast‐Kolb;C. Waydhas;P. Betz;L. Schweiberer
为了评估错误对结果的影响，并确定可预防的死亡率，我们在一家I级创伤中心进行了一项前瞻性研究(1986-1992年)，调查了40名多重创伤患者(钝性创伤；平均ISS 53分)发生的过早死亡。根据一组完整的数据分析患者的病程，我们发现了41个管理和时机错误，15个治疗错误和8个诊断问题。根据差错的严重程度可将患者分为3组：第1组(n=12；30%)未发现差错，第2组(n=22，45%)有差错，但对预后无明显影响，第3组(n=6，15%)发现差错，可能影响死亡。在40例过早死亡的病例中，没有一例可以肯定地表明不良后果是可以避免的。在对多发伤患者的护理中，管理和时机错误明显占优势，因为它们占所有发生的错误的%，并且经常发生在可预防的死亡之前(第三组为88%)。为了减少多重创伤患者管理中的错误来源，我们必须要求制定更准确的临床标准和算法，并将其引入此类患者的治疗中。
In order to assess the impact of errors on outcome and to identify the rate of preventable deaths we investigated 40 premature deaths that had occurred among polytraumatized patients (blunt trauma; average ISS 53 points) in a prospective study (years 1986-1992) in a level I trauma centre. On analysing the patients' course on the basis of a complete set of data we detected 41 management and timing errors, 15 mistakes in treatment and 8 diagnostic problems. According to the significance of the errors the patients could be divided into three groups: in group 1 (n = 12; 30%) no errors were found, in group 2 (n = 22; 45%) there were errors but these definitely had no influence on the outcome, and in group 3 (n = 6;15%) we ascertained errors with a possible influence on the deaths. In none of the 40 cases of premature death could it be definitely shown that the adverse outcome could have been avoided. In the care of polytraumatized patients there was a clear predominance of management and timing errors insofar as they accounted for 64% of all errors that occurred and had frequently preceded possibly preventable deaths (88% in group 3). To diminish sources of error in the management of polytraumatized patients we must demand that more accurate clinical standards and algorithms be developed and introduced into the treatment of such patients.