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Analysis of deaths due to injury in Milano: preliminary results
O Chiara1, A Rodriguez, J D Scott
1Istituto di Chirurgia d'Urgenza, Università di Milano, IRCCS Ospedale Maggiore di Milano.
Abstract:
We reviewed all trauma deaths occurring in the urban area of Milan during one year. Autopsy reports were cross-referenced with pre- and in-hospital records and the Injury Severity Score was calculated by a senior surgeon. Causes of deaths were defined as central nervous system injury (CNS), hemorrhage (HEM), combined central nervous system injury and hemorrhage (CNS + HEM), and burns (BURN). Places of death were considered the scene (DOS), during transportation (DOA), the emergency room (DER), and hospital. Two multidisciplinary commissions reviewed patient reports and deaths were judged non-preventable, possibly preventable or frankly preventable, using the unanimous decision rule. The TRISS method was used to calculate the probability of survival for in-hospital deaths. Overall trauma deaths were 255 with 78.04% blunt and 16.08% penetrating traumas. Burns accounted for 5.88%. CNS and CNS + HEM caused 171 (67.05%) deaths. DOS were 91, DOA 48, DER 34, and in-hospital deaths 33. Victims found dead (49 individuals) were excluded from further analysis. The commissions classified 56.31% of deaths as non-preventable, 32.03% as possibly preventable and 11.65% as frankly preventable. The Injury Severity Score decreased from DOS to in-hospital deaths (p < 0.05). The preventability rate was higher for in-hospital deaths (p < 0.05). The results of this study suggest that the development of a tiered trauma system in Milan is mandatory.
Insights
A review of trauma deaths in Milan revealed that over 11% were preventable, highlighting the urgent need for a tiered trauma system to improve survival rates.
Area of Science:
- Trauma Surgery
- Public Health
- Emergency Medicine
Background:
- Trauma remains a significant cause of mortality worldwide.
- Effective trauma systems are crucial for reducing preventable deaths.
- Milan's current trauma care infrastructure requires evaluation.
Purpose of the Study:
- To analyze trauma deaths in Milan over one year.
- To determine the preventability of these deaths.
- To assess the need for a tiered trauma system.
Main Methods:
- Review of 255 trauma death cases in Milan.
- Cross-referencing autopsy reports with medical records.
- Injury Severity Score calculation and TRISS method application.
- Multidisciplinary commission review for death preventability assessment.
Main Results:
- Central nervous system injury (CNS) and hemorrhage (HEM) were the leading causes of death (67.05%).
- Over 11% of trauma deaths were classified as frankly preventable.
- Preventability rates were significantly higher for in-hospital deaths.
Conclusions:
- A substantial proportion of trauma deaths in Milan are preventable.
- Developing a tiered trauma system is essential for Milan.
- Systemic improvements can significantly reduce trauma mortality.