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Pooled preventable death rates in trauma patients : Meta analysis and systematic review since 1990
A M Kwon1, N C Garbett2, G H Kloecker3
1Biomedical Research Institutes, Seoul National University Hospital, Seoul National University, 101 Daehak ro, Jongro-gu, Seoul, Korea. amykwon@snu.ac.kr.
Purpose:
To estimate the pooled PDRs (preventable death rates) with articles being published since 1990, and compare the differences of PDRs over time and according to the evaluation approaches to determine preventable deaths.
Methods:
Articles concerning preventable deaths of trauma patients published between 1990 and 2013 were systematically reviewed, and the pooled PDRs with 95 % confidence intervals were estimated using meta-analysis. It was also observed whether the PDRs differed over time and according to the evaluation approaches employed for determining preventable deaths.
Results:
Twenty seven articles were identified through bibliographic searches using PUBMED with the keywords of 'preventable deaths', 'the cause of deaths' and 'trauma'. Mean ages of the trauma patients in the selected articles ranged from 32.9 to 58 years old and 72 % were male on average. The pooled PDR was estimated as 0.20 with 95 % CI (0.16, 0.25) with a p-value of 0.0001, and the differences of PDRs over time and according to the employed approaches were not statistically significant with p-values of 0.06 and 0.99, respectively. However, PDRs determined by statistical approaches alone showed greater dispersion in comparison with the 'panel review approach'.
Conclusions:
This article provided some insights about the trauma care system by computing the pooled estimate of PDRs over the past 23 years as an indicator. The pooled PDR was estimated as approximately 20 %, with no statistical significance of differences in PDRs over time or by the evaluation methods employed. That left us still room for improvement in trauma care system despite our efforts to reduce PDRs. In addition, when 'statistical approaches' are applied alone to estimate PDRs, we recommend that statistical methods should be applied with caution when the characteristics of trauma patients are heterogeneous. The optimal approach might be to combine both statistical and panel review approaches instead of employing a single approach.
