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Related Experiment Videos

Practical evaluation of trauma deaths.

S E Pories1, R L Gamelli, D B Pilcher

  • 1Department of Surgery, University of Vermont College of Medicine, Burlington 05405.

The Journal of Trauma
|December 1, 1989
PubMed
Summary

This study introduces a combined TRISS and Toronto method for auditing trauma deaths. This approach improves the identification of deaths requiring in-depth review of hospital care, enhancing patient safety initiatives.

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Area of Science:

  • Trauma Surgery
  • Medical Auditing
  • Patient Safety

Background:

  • Current trauma death audit methods, TRISS and the Toronto method, have limitations in identifying all deaths appropriate for in-depth review.
  • TRISS may include deaths due to underlying medical conditions, while the Toronto method might exclude deaths from system failures.
  • A refined audit strategy is needed to accurately target deaths for comprehensive hospital care evaluation.

Purpose of the Study:

  • To propose and evaluate a combined TRISS and Toronto method for auditing trauma deaths.
  • To enhance the identification of deaths that are truly appropriate for detailed review of hospital care.
  • To improve the accuracy and efficiency of trauma death audits for patient safety.

Main Methods:

  • A retrospective audit of 54 trauma deaths over 22 months was conducted.

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  • Deaths were categorized as frankly preventable, potentially salvageable, or nonpreventable.
  • The study compared the efficacy of the TRISS method, the Toronto method, and a combined approach in identifying potentially salvageable deaths.

    • Main Results:

    • The combined TRISS and Toronto method demonstrated a higher predictive value (84.6%) compared to the TRISS method alone (54.5%) and the Toronto method alone (52.4%).
    • Potentially salvageable deaths were more likely to be identified by both methods when used in combination.
    • Deaths identified by only one method were more likely to be nonpreventable, suggesting the combined approach better targets relevant cases.

    Conclusions:

    • Combining the TRISS and Toronto methods offers a more effective and accurate approach to auditing trauma deaths.
    • This integrated method improves the identification of deaths requiring in-depth review of hospital care.
    • The proposed simple, computerized method is practical and cost-effective for targeting deaths for detailed review, ultimately aiming to improve patient outcomes.