Establishing a Regional Trauma Preventable/Potentially Preventable Death Rate
Establishing a Regional Trauma Preventable/Potentially Preventable Death Rate
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DOI：
10.1097/sla.0000000000002999
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发表时间：
2020-02-01
影响因子：
9
通讯作者：
Wade, Charles E.
中科院分区：
文献类型：
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作者：
Drake, Stacy A.;Holcomb, John B.;Wade, Charles E.
目的：建立德克萨斯州一个人口稠密县的创伤可预防/潜在可预防死亡率（PPPDR）。美国国家科学院估计，美国的创伤可预防死亡率为20%，呼吁实现零可预防死亡，同时承认缺乏准确的可预防死亡率。在这种情况下，提高创伤系统护理质量的有效战略仍然是困难的。方法：回顾性分析2014年发生在德克萨斯州哈里斯县440万不同人口的死亡相关记录。评估了患者人口统计学、损伤机制、原因、时间和死亡地点。使用统一的标准对死亡进行分类，并将其记录为可预防、潜在可预防或不可预防。结果：在1848例死亡中，85%的人进行了尸检，99.7%的人被指定为可预防水平，导致36.2%的创伤PPPDR。性别、年龄和种族/民族在可预防类别中存在差异（P< 0.01）。在847例院前死亡中，758例（89.5%）是不可预防的。在89例院前可预防/潜在可预防（P/PP）死亡中，出血占55.1%。在657例急诊死亡中，292例（44.4%）为P/PP；其中，出血、败血症和创伤性脑损伤占73.3%。在339例初次住院死亡中，287例（84.7%）为P/PP，其中117例死于败血症，31例死于肺血栓栓塞，占51.6%。结论：创伤PPPDR几乎是美国国家科学院估计的两倍。关于P/PP死亡的数据为针对创伤系统的各个阶段进行针对性的研究、预防、干预和治疗提供了机会。
Objective: To establish a trauma preventable/potentially preventable death rate (PPPDR) within a heavily populated county in Texas. The National Academies of Sciences estimated the trauma preventable death rate in the United States to be 20%, issued a call for zero preventable deaths, while acknowledging that an accurate preventable death rate was lacking. In this absence, effective strategies to improve quality of care across trauma systems will remain difficult. Methods: A retrospective review of death-related records that occurred during 2014 in Harris County, TX, a diverse population of 4.4 million. Patient demographics, mechanism of injury, cause, timing, and location of deaths were assessed. Deaths were categorized using uniform criteria and recorded as preventable, potentially preventable or nonpreventable. Results: Of 1848 deaths, 85% had an autopsy and 99.7% were assigned a level of preventability, resulting in a trauma PPPDR of 36.2%. Sex, age, and race/ethnicity varied across preventability categories (P< 0.01). Of 847 prehospital deaths, 758 (89.5%) were nonpreventable. Among 89 prehospital preventable/potentially preventable (P/PP) deaths, hemorrhage accounted for 55.1%. Of the 657 initial acute care setting deaths, 292 (44.4%) were P/PP; of these, hemorrhage, sepsis, and traumatic brain injury accounted for 73.3%. Of 339 deaths occurring after initial hospitalization, 287 (84.7%) were P/PP, of these 117 resulted from sepsis and 31 from pulmonary thromboembolism, accounted for 51.6%. Conclusions: The trauma PPPDR was almost double that estimated by the National Academies of Sciences. Data regarding P/PP deaths offers opportunity to target research, prevention, intervention, and treatment corresponding to all phases of the trauma system.