Seven hundred fifty-three consecutive deaths in a Level I trauma center

The argument for injury prevention

Ronald M Stewart, John G Myers, Daniel L Dent, Peter Ermis, Gina A. Gray, Roberto Villarreal, Osbert Blow, Brian Woods, Marilyn McFarland, Jan Garavaglia, Harlan D Root, Basil A Pruitt, Stephen Flaherty, James W. Davis

Research output: Contribution to journalArticle

177 Citations (Scopus)

Abstract

Background: The past century has seen improvement in trauma care, with a resulting decrease in therapeutically preventable deaths. We hypothesize that further major reduction in injury mortality will be obtained through injury prevention, rather than improvements in therapy. Methods: Seven hundred fifty-three deaths in an American College of Surgeons-verified, Level I trauma center were reviewed as they occurred. Deaths were classified as therapeutically not preventable, possibly preventable, or preventable. These charts were also reviewed for factors that might have prevented or lessened the severity of the injury. Results: Mean age was 43, mean Glasgow Coma Scale score was 5, mean Revised Trauma Score was 4, mean Injury Severity Score was 41, and mean probability of survival was 0.25 (according to TRISS). Forty-six percent underwent cardiopulmonary resuscitation in the field, 52% died within 12 hours, 74% died within 48 hours, and 86% died within 7 days. Primary causes of death included central nervous system injury in 51%, irreversible shock in 21%, multiple injuries (shock plus central nervous system injury) in 9%, multiple organ failure/sepsis and other causes in 3%, and pulmonary embolus in 0.1%. Seven hundred one (93%) were classified as not preventable with a change in therapy, 32 (4.2%) were classified as potentially preventable with a change in therapy, and 20 were classified as preventable with a change in therapy (2.6%). Forty-six percent had cardiopulmonary resuscitation performed before or immediately on arrival to the hospital. Another 23% had vital signs present on arrival, but had a Glasgow Coma Scale score of ≤ 4. Of the 546 unintentionally injured patients, 58% had an identifiable factor that contributed to the presence and/or severity of the injury (intoxication, restraint and helmet use), with 28% of patients having a positive blood alcohol level. Of the 206 patients with intentional injuries, 44% were intoxicated at the time of their death. Commensurate with driving-while-intoxicated prevention program(s), the percentage of intoxicated patients significantly (p = 0.03) decreased from 45% to 34% over the same 7-year period. Conclusion: Dramatically improving therapy (no errors, cure for multiple organ failure, sepsis, and pulmonary embolus) in a modern trauma system would decrease trauma mortality by 13%. In contrast, more than half of all deaths are potentially preventable with preinjury behavioral changes. Injury prevention is critical to reducing deaths in the modern trauma system.

Original languageEnglish (US)
Pages (from-to)66-71
Number of pages6
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume54
Issue number1
DOIs
StatePublished - Jan 1 2003

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Trauma Centers
Wounds and Injuries
Nervous System Trauma
Glasgow Coma Scale
Multiple Organ Failure
Cardiopulmonary Resuscitation
Embolism
Shock
Sepsis
Central Nervous System
Therapeutics
Head Protective Devices
Lung
Injury Severity Score
Mortality
Vital Signs
Multiple Trauma
Cause of Death

Keywords

  • Alcohol
  • Death
  • Injury
  • Mortality
  • Prevention
  • Risk
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

Seven hundred fifty-three consecutive deaths in a Level I trauma center : The argument for injury prevention. / Stewart, Ronald M; Myers, John G; Dent, Daniel L; Ermis, Peter; Gray, Gina A.; Villarreal, Roberto; Blow, Osbert; Woods, Brian; McFarland, Marilyn; Garavaglia, Jan; Root, Harlan D; Pruitt, Basil A; Flaherty, Stephen; Davis, James W.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 54, No. 1, 01.01.2003, p. 66-71.

Research output: Contribution to journalArticle

Stewart, RM, Myers, JG, Dent, DL, Ermis, P, Gray, GA, Villarreal, R, Blow, O, Woods, B, McFarland, M, Garavaglia, J, Root, HD, Pruitt, BA, Flaherty, S & Davis, JW 2003, 'Seven hundred fifty-three consecutive deaths in a Level I trauma center: The argument for injury prevention', Journal of Trauma - Injury, Infection and Critical Care, vol. 54, no. 1, pp. 66-71. https://doi.org/10.1097/00005373-200301000-00009
Stewart, Ronald M ; Myers, John G ; Dent, Daniel L ; Ermis, Peter ; Gray, Gina A. ; Villarreal, Roberto ; Blow, Osbert ; Woods, Brian ; McFarland, Marilyn ; Garavaglia, Jan ; Root, Harlan D ; Pruitt, Basil A ; Flaherty, Stephen ; Davis, James W. / Seven hundred fifty-three consecutive deaths in a Level I trauma center : The argument for injury prevention. In: Journal of Trauma - Injury, Infection and Critical Care. 2003 ; Vol. 54, No. 1. pp. 66-71.
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abstract = "Background: The past century has seen improvement in trauma care, with a resulting decrease in therapeutically preventable deaths. We hypothesize that further major reduction in injury mortality will be obtained through injury prevention, rather than improvements in therapy. Methods: Seven hundred fifty-three deaths in an American College of Surgeons-verified, Level I trauma center were reviewed as they occurred. Deaths were classified as therapeutically not preventable, possibly preventable, or preventable. These charts were also reviewed for factors that might have prevented or lessened the severity of the injury. Results: Mean age was 43, mean Glasgow Coma Scale score was 5, mean Revised Trauma Score was 4, mean Injury Severity Score was 41, and mean probability of survival was 0.25 (according to TRISS). Forty-six percent underwent cardiopulmonary resuscitation in the field, 52{\%} died within 12 hours, 74{\%} died within 48 hours, and 86{\%} died within 7 days. Primary causes of death included central nervous system injury in 51{\%}, irreversible shock in 21{\%}, multiple injuries (shock plus central nervous system injury) in 9{\%}, multiple organ failure/sepsis and other causes in 3{\%}, and pulmonary embolus in 0.1{\%}. Seven hundred one (93{\%}) were classified as not preventable with a change in therapy, 32 (4.2{\%}) were classified as potentially preventable with a change in therapy, and 20 were classified as preventable with a change in therapy (2.6{\%}). Forty-six percent had cardiopulmonary resuscitation performed before or immediately on arrival to the hospital. Another 23{\%} had vital signs present on arrival, but had a Glasgow Coma Scale score of ≤ 4. Of the 546 unintentionally injured patients, 58{\%} had an identifiable factor that contributed to the presence and/or severity of the injury (intoxication, restraint and helmet use), with 28{\%} of patients having a positive blood alcohol level. Of the 206 patients with intentional injuries, 44{\%} were intoxicated at the time of their death. Commensurate with driving-while-intoxicated prevention program(s), the percentage of intoxicated patients significantly (p = 0.03) decreased from 45{\%} to 34{\%} over the same 7-year period. Conclusion: Dramatically improving therapy (no errors, cure for multiple organ failure, sepsis, and pulmonary embolus) in a modern trauma system would decrease trauma mortality by 13{\%}. In contrast, more than half of all deaths are potentially preventable with preinjury behavioral changes. Injury prevention is critical to reducing deaths in the modern trauma system.",
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T2 - The argument for injury prevention

AU - Stewart, Ronald M

AU - Myers, John G

AU - Dent, Daniel L

AU - Ermis, Peter

AU - Gray, Gina A.

AU - Villarreal, Roberto

AU - Blow, Osbert

AU - Woods, Brian

AU - McFarland, Marilyn

AU - Garavaglia, Jan

AU - Root, Harlan D

AU - Pruitt, Basil A

AU - Flaherty, Stephen

AU - Davis, James W.

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N2 - Background: The past century has seen improvement in trauma care, with a resulting decrease in therapeutically preventable deaths. We hypothesize that further major reduction in injury mortality will be obtained through injury prevention, rather than improvements in therapy. Methods: Seven hundred fifty-three deaths in an American College of Surgeons-verified, Level I trauma center were reviewed as they occurred. Deaths were classified as therapeutically not preventable, possibly preventable, or preventable. These charts were also reviewed for factors that might have prevented or lessened the severity of the injury. Results: Mean age was 43, mean Glasgow Coma Scale score was 5, mean Revised Trauma Score was 4, mean Injury Severity Score was 41, and mean probability of survival was 0.25 (according to TRISS). Forty-six percent underwent cardiopulmonary resuscitation in the field, 52% died within 12 hours, 74% died within 48 hours, and 86% died within 7 days. Primary causes of death included central nervous system injury in 51%, irreversible shock in 21%, multiple injuries (shock plus central nervous system injury) in 9%, multiple organ failure/sepsis and other causes in 3%, and pulmonary embolus in 0.1%. Seven hundred one (93%) were classified as not preventable with a change in therapy, 32 (4.2%) were classified as potentially preventable with a change in therapy, and 20 were classified as preventable with a change in therapy (2.6%). Forty-six percent had cardiopulmonary resuscitation performed before or immediately on arrival to the hospital. Another 23% had vital signs present on arrival, but had a Glasgow Coma Scale score of ≤ 4. Of the 546 unintentionally injured patients, 58% had an identifiable factor that contributed to the presence and/or severity of the injury (intoxication, restraint and helmet use), with 28% of patients having a positive blood alcohol level. Of the 206 patients with intentional injuries, 44% were intoxicated at the time of their death. Commensurate with driving-while-intoxicated prevention program(s), the percentage of intoxicated patients significantly (p = 0.03) decreased from 45% to 34% over the same 7-year period. Conclusion: Dramatically improving therapy (no errors, cure for multiple organ failure, sepsis, and pulmonary embolus) in a modern trauma system would decrease trauma mortality by 13%. In contrast, more than half of all deaths are potentially preventable with preinjury behavioral changes. Injury prevention is critical to reducing deaths in the modern trauma system.

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KW - Alcohol

KW - Death

KW - Injury

KW - Mortality

KW - Prevention

KW - Risk

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