Analysis of preventable pediatric trauma deaths and inappropriate trauma care in Montana
Related Experiment Video
Updated: Oct 19, 2026
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
T J Esposito1, N D Sanddal, J M Dean
1Burn & Shock Trauma Institute and the Department of Surgery, Loyola University, Maywood, Illinois 60153, USA. tesposi@luc.edu
Insights
Preventable pediatric trauma deaths in rural areas are low, especially compared to adults. Inappropriate care, particularly in emergency departments, often involves airway and chest injuries in children under 14.
Area of Science:
- Pediatric Trauma Care
- Rural Health Outcomes
- Medical Error Analysis
Background:
- Traumatic injuries are a leading cause of death in children.
- Understanding preventable deaths and care errors is crucial for improving outcomes.
- Rural settings present unique challenges in pediatric trauma management.
Purpose of the Study:
- To determine rates of preventable mortality in pediatric trauma cases in a rural state.
- To identify and characterize inappropriate care and treatment errors in these cases.
- To compare pediatric trauma outcomes with those of the adult population.
Main Methods:
- Retrospective review of pediatric mechanical trauma deaths (aged ≤18) in Montana (1989-1992).
- Multidisciplinary consensus panel assessed care appropriateness against national guidelines.
- Compared pediatric preventable death and inappropriate care rates with adult data.
Main Results:
- Overall pediatric preventable death rate was 9% (16% for in-hospital deaths).
- Inappropriate care occurred in 36% of all cases, highest in the emergency department (ED) (47%).
- Inappropriate care was more common in children ≤14, primarily involving airway and chest trauma management.
Conclusions:
- Preventable pediatric trauma mortality in rural areas is low, lower than in adults.
- Inappropriate trauma care is frequent in children, especially in the ED, linked to airway/chest injury management.
- Targeted education for ED providers on pediatric trauma stabilization may reduce preventable deaths.
Objective:
To determine the rates of preventable mortality and inappropriate care, as well as the nature of treatment errors associated with pediatric traumatic deaths occurring in a rural state.
Methods:
Retrospective multidisciplinary consensus panel review of deaths attributed to mechanical trauma in children aged 18 years or less, occurring in Montana between October 1, 1989, and September 30, 1992. The care rendered in both preventable and nonpreventable cases was evaluated for appropriateness according to nationally accepted guidelines. Rates of pediatric preventable death and inappropriate care, as well as the nature of inappropriate care, were compared with that of the adult population.
Results:
One hundred thirty-eight cases were reviewed. One death (less than 1%) was judged frankly preventable, 11 deaths (8%) were judged possibly preventable, giving a total preventability rate of 9% for all cases reviewed. Considering only in-hospital deaths (n = 77), the total preventability rate was 16%. The rate of inappropriate care rendered for all deaths, regardless of preventability, was 36%. The rate of inappropriate care in the prehospital phase was 16%; for in-hospital deaths, it was 47%. In the emergency department (ED), the rate was 36%, and in post-ED care, 22%. In comparison to the adult population, the rates of preventable death (9% vs. 14%) and inappropriate care in the hospital phase (64% vs. 66%) were lower. Inappropriate care for the pediatric group was more prevalent in patients less than or equal to 14 years old. The nature of inappropriate care was most frequently associated with the management of respiratory problems, including airway control and management of chest trauma.
Conclusion:
Preventable mortality from traumatic injuries in children in a rural state appears to be low, and lower than that reported for adult trauma victims in the same state. A preponderance of these preventable deaths occur in the subgroup of children less than or equal to 14 years if age. Inappropriate trauma care in children occurs frequently, particularly in the ED phase of care, and is primarily associated with the management of the airway and chest injuries. Education of ED primary care providers in basic principles of stabilization and initial treatment of the injured child 14 years old or younger may be the most effective method of reducing preventable trauma deaths in the rural setting.
