THE MANAGEMENT OF INJURIES –A REVIEW OF DEATHS IN HOSPITAL

S. A. Deane*, P. L. Gawky, P. Woods, D. Cass, M. J. Hollands, R. J. Cook, C. Read

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

58 Citations (Scopus)

Abstract

A prospective review was undertaken of the management of III 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%, hut 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 management should all decrease the death rate from injuries particularly in patients without severe head injury.

Original languageEnglish
Pages (from-to)463-469
Number of pages7
JournalAustralian and New Zealand Journal of Surgery
Volume58
Issue number6
DOIs
Publication statusPublished - 1988
Externally publishedYes

Keywords

  • deaths in hospital
  • injuries
  • injury severity score
  • preventable deaths
  • trauma
  • trauma score

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