THE MANAGEMENT OF INJURIES A REVIEW OF DEATHS IN HOSPITAL
THE MANAGEMENT OF INJURIES A REVIEW OF DEATHS IN HOSPITAL
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DOI：
10.1111/j.1445-2197.1988.tb06236.x
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发表时间：
1988-01-01
期刊：
影响因子：
--
通讯作者：
READ C
中科院分区：
文献类型：
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作者：
DEANE S A;GAUDRY P L;READ C
对111例因受伤入院治疗后在医院死亡的连续患者的管理进行了前瞻性审查。创伤死亡审核委员会的每个成员，然后由整个委员会审查与每个患者相关的标准数据集。所有病人的尸检报告都有。得出的结论是关于缺陷方面的病人管理和可能避免每一个死亡。使用创伤评分（TS）和损伤严重度评分（ISS）评估损伤严重度。可能避免的死亡（PAD）率为17%。最常见的管理缺陷与液体复苏不足和最终管理延迟有关。对PAD发生率的最大贡献是液体复苏不足、延迟和对损伤严重程度或临床恶化意义的认识不足。年龄的增加与PAD的发生率增加有关。在存在严重头部损伤的情况下，PAD率为8%，但在没有严重头部损伤的情况下，PAD率为63%。它的结论是，审查所有的创伤死亡是一个可以实现的，有益的和必要的一部分，以医院为基础的综合创伤服务。TS和ISS的敏感性不足以证明其用于选择死亡进行审查的合理性。改进的血容量替代，更早和更直接的管理和高级专家工作人员的监督，以及消除延误病人管理的原因，都应该降低受伤的死亡率，特别是在没有严重头部损伤的病人中。
A prospective review was undertaken of the management of 111 consecutive patients who died in hospital after admission for treatment of injuries. A standard set of data relating to each patient was reviewed by each member of a trauma death audit committee and then by the whole committee. Autopsy reports were available on all patients. Conclusions were drawn concerning defective aspects of patient management and possible avoidance of each death. Injury severity was assessed using the Trauma Score (TS) and Injury Severity Score (ISS). The possibly avoidable death (PAD) rate was 17%. The most common defects in management were related to inadequate fluid resuscitation and delays in definitive management. The greatest contributions to the PAD rate were from inadequate fluid resuscitation, delays and inadequate perception of the severity of injuries or significance of clinical deterioration. Increasing age was related to a higher frequency of PAD. PAD rate in the presence of severe head injury was 8%, but was 63% in the absence of a severe head injury. It is concluded that review of all trauma deaths is an achievable, beneficial and essential part of a hospital-based integrated trauma service. TS and ISS are not sufficiently sensitive to justify their use in selecting deaths for review. Improved blood volume replacement, earlier and more direct management and supervision by senior specialist staff, and elimination of causes of delay in patient mangement should all decrease the death rate from injuries particularly in patients without severe head injury.