PW 1935 Reviewing prehospital trauma deaths

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IntroductionThe majority of trauma deaths will occur in the prehospital setting. However, as detailed injury data on prehospital trauma deaths is not routinely collected, these deaths have not been subject to the same scrutiny as in-hospital deaths. The aim of this study was to identify the proportion of trauma deaths in which the anatomical injuries sustained were potentially survivable.MethodsWe performed a population-based retrospective analysis of prehospital and early (<24 hours) in-hospital trauma deaths attended by Ambulance Victoria (AV) in Victoria, Australia, between 2008–2014. Prehospital data from the Victorian Ambulance Cardiac Arrest Registry and in-hospital data from the Victorian State Trauma Registry was linked to autopsy data from the National Coronial Information System (NCIS). Full autopsies were independently reviewed by two emergency physicians who classified the anatomical injuries as ‘survivable’ and ‘unsurvivable’, as per Davis et al.1ResultsOver the study period, there were 2759 trauma-related deaths attended by AV. Of the 777 patients that received attempted resuscitation, 692 cases (89%) were linked to NCIS data and of these, 334 (48%) had full autopsies. For cases with a full autopsy, 123 (37%) had ‘survivable’ injuries, 185 (55%) had ‘unsurvivable’ injuries and 26 (8%) were primary medical conditions that lead to a secondary trauma event.ConclusionsMore than one-third of trauma patients who had attempted resuscitation, but subsequently died, had anatomical injuries that were considered ‘survivable’. These cases will now undergo detailed review to identify situations where current best evidence care was not delivered and opportunities for improvements in the system of care.Reference. Davis JS, Satahoo SS, Butler FK, et al. An analysis of prehospital deaths: Who can we save?Journal of Trauma and Acute Care Surgery2014;77(2):213–218.

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