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Preventable pediatric trauma deaths in Ontario: a comparative population-based study
Ivan R Diamond1, Patricia C Parkin, Paul W Wales
1Division of General Surgery, The Hospital for Sick Children, Toronto, Canada.
Insights
Pediatric trauma deaths in Ontario have significantly decreased, with preventable deaths dropping from 21% to 7%. Trauma system improvements are credited with this threefold decline, saving one preventable death for every seven injury fatalities.
Area of Science:
- Pediatric Trauma Care
- Injury Prevention Research
- Public Health Systems Analysis
Background:
- Previous studies identified 21% of pediatric trauma deaths in Ontario (1985-1987) as preventable.
- Significant trauma system enhancements have been implemented since the initial study period.
Purpose of the Study:
- To re-evaluate the preventable trauma death rate in pediatric (<16 years) patients in Ontario.
- To assess the impact of trauma system improvements on mortality rates using consistent methodology.
Main Methods:
- Analysis of pediatric (<16 years) trauma death records in Ontario from 2001-2003.
- Comparison with data from 1985-1987 using identical criteria for preventability.
- Exclusion of cases where care was not sought and deaths due to asphyxia.
Main Results:
- A preventable death rate of 7% was identified in the 2001-2003 cohort.
- This represents a significant decline from the previous 21% rate (p < 0.001).
- A relative risk reduction of 68% for preventable death was observed.
Conclusions:
- The threefold decline in preventable pediatric trauma deaths suggests the effectiveness of trauma system improvements.
- System changes are estimated to have eliminated one preventable death for every seven fatal injuries.
Introduction:
Previously, we demonstrated that 21% of pediatric (<16 years) trauma deaths in the Province of Ontario during the period 1985 to 1987 were potentially preventable. Since then many trauma system changes have occurred including field triage, designation of trauma centers, and improved injury prevention. This study aims to examine the current preventable trauma death rate in our system using identical methodology to our previous study.
Method:
The records of all children (<16 years) who died in Ontario from 2001 to 2003 after blunt or penetrating trauma were obtained from the Chief Coroner and compared with those in our previous report. In both series, we excluded cases where care was not sought and all deaths due to asphyxia. Deaths were considered unpreventable if the Injury Severity Score, based on Abbreviated Injury Scale 1985, was >59; or if there was a head injury that received an Abbreviated Injury Scale score of 5 with the exception of isolated extra-axial hematomas.
Results:
Eleven preventable deaths were identified. The preventable death rate was 7%, a significant decline from the 21% previously identified (p < 0.001; relative risk reduction for preventable death, 68% [95% confidence interval, 42-83%]; number needed to treat, 7).
Conclusion:
There has been a threefold decline in the preventable death rate, which we believe is related to improvements in the trauma system. We estimated that, for every seven deaths from fatal injuries, system changes between the two study periods eliminated one preventable death.
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