Traumatic deaths in the emergency room: A retrospective analysis of 115 consecutive cases

The aim of the present study was to characterise traumatic deaths occurring in the emergency room (ER) and to assess retrospectively the quality of given emergency care by evaluating whether any of the deaths could be identified as potentially preventable.

All consecutive deaths of trauma patients between 1 January 1998 and 31 December 2006 in the ER of the Töölö Hospital Trauma Centre were retrospectively reviewed. The inclusion criterion was death of a trauma patient occurring in the ER. Both the pre- and inhospital medical charts and the autopsy reports of the patients were reviewed.

A total of 115 patients fulfilled the inclusion criteria, and the autopsy reports were obtained for all of these cases (100%). The patients were mainly males (n = 84; 73%), and the median age of the patients was 51 years (range 1-93 years). The average injury severity score (ISS) was 34.6. Blunt trauma was the most common type of injury in the study population. A total of 115 injuries in 50 patients were missed in both the clinical and radiological surveys in the ER, i.e., a missed injury was identified in 43% of the cases. Of these patients, 15.7% had a clinically significant missed injury (AIS ≥ 4). Based on our review of all available material, we consider that 11 deaths (9.6%) were potentially preventable.

Missed injuries did not play a major role in the preventable deaths. Seven potentially preventable deaths were considered to be failures in the surgical decision-making process, resulting in futile non-operative treatment or a delay in surgical bleeding control.