Frontiers in Sustainable Cities (Jun 2020)
Preventable Trauma Deaths Rate (PTDR)—Analysis of Variables That Shape Its Value With Patterns of Errors Contributing to Trauma Mortality. Fifteen Years of Experience Based on the Example of a Polish Specialist Regional Hospital
Abstract
This analysis is based on a review of 224 out of 323 cases of trauma deaths in Regional Specialist Hospital of Grudziądz during the period of 2003–2017. In this study, we have described and systematized the most common situations resulting in severe personal injury. We then evaluated whether the diagnostic procedures and treatments that were employed were correct. From the objective statistical parameters described, we evaluate the level of quality of emergency medicine and the effectiveness of the integrated medical rescue system. Ultimately, the most significant component is PTDR (preventable trauma death rate). Inspiration for our research came from direct observation of our daily experiences in the ED where we derived great satisfaction from treating patients successfully. More importantly, however, we suffered the severe disappointments of failure that always and inevitably raised the same question: Have we done everything humanely possible to save this patient? In the daily struggle of saving lives, the question always remains: What could we have done differently? Better? More effectively? To answer this question, we have to examine our emergency procedures and activities. Were they correct and effective? This documentation not only shows us a statistical picture of the injuries sustained by trauma victims, but also presents a dynamic reconstruction of events as well as the pathophysiology of dying. When we view all this material as a complete picture, we see that it provides the opportunity to assess the accuracy of judgment, especially during the critical moments of diagnosis and subsequent treatment of the casualties. Not only did we describe the anatomic results of injuries, including rankings to proper regions of the body, we also reconstructed the pathophysiology of dying such as airway obstruction—suffocation, bleeding—exsanguination, or severe complications such as acute respiratory distress syndrome, pulmonary emboli, thrombosis of intracranial vasculature, and fatal, irreversible organ damage. We checked operating procedures that had been done and those that should have been done to give the patient a chance for survival but were not due to wrong decisions. We have demonstrated that the element of time is critically important in diagnosing and implementing treatment of patients with major injuries; further, we have enumerated the potential complications, time errors, missed injury, and general mismanagement as professional risks for the emergency team: physicians, nurses, and paramedics. We have determined that almost half of all trauma deaths occur within the first 2 days following major injury, with most of those occurring within the first 6 h of hospitalization. The other deaths—“late deaths”—are the result of unsuccessful treatment or the development of complications in intensive care unit. In all hospital trauma deaths the leading causes are severity of brain injury (51%), exsanguination (31%), and asphyxiation (13%).
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