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Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths

BACKGROUND: A systematic analysis of trauma deaths is a step towards trauma quality improvement in Indian hospitals. This study estimates the magnitude of preventable trauma deaths in five Indian hospitals, and uses a peer-review process to identify opportunities for improvement (OFI) in trauma care...

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Autores principales: Roy, Nobhojit, Kizhakke Veetil, Deepa, Khajanchi, Monty Uttam, Kumar, Vineet, Solomon, Harris, Kamble, Jyoti, Basak, Debojit, Tomson, Göran, von Schreeb, Johan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314603/
https://www.ncbi.nlm.nih.gov/pubmed/28209192
http://dx.doi.org/10.1186/s12913-017-2085-7
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author Roy, Nobhojit
Kizhakke Veetil, Deepa
Khajanchi, Monty Uttam
Kumar, Vineet
Solomon, Harris
Kamble, Jyoti
Basak, Debojit
Tomson, Göran
von Schreeb, Johan
author_facet Roy, Nobhojit
Kizhakke Veetil, Deepa
Khajanchi, Monty Uttam
Kumar, Vineet
Solomon, Harris
Kamble, Jyoti
Basak, Debojit
Tomson, Göran
von Schreeb, Johan
author_sort Roy, Nobhojit
collection PubMed
description BACKGROUND: A systematic analysis of trauma deaths is a step towards trauma quality improvement in Indian hospitals. This study estimates the magnitude of preventable trauma deaths in five Indian hospitals, and uses a peer-review process to identify opportunities for improvement (OFI) in trauma care delivery. METHODS: All trauma deaths that occurred within 30 days of hospitalization in five urban university hospitals in India were retrospectively abstracted for demography, mechanism of injury, transfer status, injury description by clinical, investigation and operative findings. Using mixed methods, they were quantitatively stratified by the standardized Injury Severity Score (ISS) into mild (1–8), moderate (9–15), severe (16–25), profound (26–75) ISS categories, and by time to death within 24 h, 7, or 30 days. Using peer-review and Delphi methods, we defined optimal trauma care within the Indian context and evaluated each death for preventability, using the following categories: Preventable (P), Potentially preventable (PP), Non-preventable (NP) and Non-preventable but care could have been improved (NPI). RESULTS: During the 18 month study period, there were 11,671 trauma admissions and 2523 deaths within 30 days (21.6%). The overall proportion of preventable deaths was 58%, among 2057 eligible deaths. In patients with a mild ISS score, 71% of deaths were preventable. In the moderate category, 56% were preventable, and 60% in the severe group and 44% in the profound group were preventable. Traumatic brain injury and burns accounted for the majority of non-preventable deaths. The important areas for improvement in the preventable deaths subset, inadequacies in airway management (14.3%) and resuscitation with hemorrhage control (16.3%). System-related issues included lack of protocols, lack of adherence to protocols, pre-hospital delays and delays in imaging. CONCLUSION: Fifty-eight percent of all trauma deaths were classified as preventable. Two-thirds of the deaths with injury severity scores of less than 16 were preventable. This large subgroup of Indian urban trauma patients could possibly be saved by urgent attention and corrective action. Low-cost interventions such as airway management, fluid resuscitation, hemorrhage control and surgical decision-making protocols, were identified as OFI. Establishment of clinical protocols and timely processes of trauma care delivery are the next steps towards improving care.
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spelling pubmed-53146032017-02-24 Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths Roy, Nobhojit Kizhakke Veetil, Deepa Khajanchi, Monty Uttam Kumar, Vineet Solomon, Harris Kamble, Jyoti Basak, Debojit Tomson, Göran von Schreeb, Johan BMC Health Serv Res Research Article BACKGROUND: A systematic analysis of trauma deaths is a step towards trauma quality improvement in Indian hospitals. This study estimates the magnitude of preventable trauma deaths in five Indian hospitals, and uses a peer-review process to identify opportunities for improvement (OFI) in trauma care delivery. METHODS: All trauma deaths that occurred within 30 days of hospitalization in five urban university hospitals in India were retrospectively abstracted for demography, mechanism of injury, transfer status, injury description by clinical, investigation and operative findings. Using mixed methods, they were quantitatively stratified by the standardized Injury Severity Score (ISS) into mild (1–8), moderate (9–15), severe (16–25), profound (26–75) ISS categories, and by time to death within 24 h, 7, or 30 days. Using peer-review and Delphi methods, we defined optimal trauma care within the Indian context and evaluated each death for preventability, using the following categories: Preventable (P), Potentially preventable (PP), Non-preventable (NP) and Non-preventable but care could have been improved (NPI). RESULTS: During the 18 month study period, there were 11,671 trauma admissions and 2523 deaths within 30 days (21.6%). The overall proportion of preventable deaths was 58%, among 2057 eligible deaths. In patients with a mild ISS score, 71% of deaths were preventable. In the moderate category, 56% were preventable, and 60% in the severe group and 44% in the profound group were preventable. Traumatic brain injury and burns accounted for the majority of non-preventable deaths. The important areas for improvement in the preventable deaths subset, inadequacies in airway management (14.3%) and resuscitation with hemorrhage control (16.3%). System-related issues included lack of protocols, lack of adherence to protocols, pre-hospital delays and delays in imaging. CONCLUSION: Fifty-eight percent of all trauma deaths were classified as preventable. Two-thirds of the deaths with injury severity scores of less than 16 were preventable. This large subgroup of Indian urban trauma patients could possibly be saved by urgent attention and corrective action. Low-cost interventions such as airway management, fluid resuscitation, hemorrhage control and surgical decision-making protocols, were identified as OFI. Establishment of clinical protocols and timely processes of trauma care delivery are the next steps towards improving care. BioMed Central 2017-02-16 /pmc/articles/PMC5314603/ /pubmed/28209192 http://dx.doi.org/10.1186/s12913-017-2085-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Roy, Nobhojit
Kizhakke Veetil, Deepa
Khajanchi, Monty Uttam
Kumar, Vineet
Solomon, Harris
Kamble, Jyoti
Basak, Debojit
Tomson, Göran
von Schreeb, Johan
Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths
title Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths
title_full Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths
title_fullStr Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths
title_full_unstemmed Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths
title_short Learning from 2523 trauma deaths in India- opportunities to prevent in-hospital deaths
title_sort learning from 2523 trauma deaths in india- opportunities to prevent in-hospital deaths
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5314603/
https://www.ncbi.nlm.nih.gov/pubmed/28209192
http://dx.doi.org/10.1186/s12913-017-2085-7
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