Preventable trauma deaths in The Netherlands--a prospective multicenter study

The data of all trauma fatalities occurring in 12 Dutch hospitals during a period of 1 year were reviewed for management errors and preventable deaths by a panel of five surgeons trained in trauma care. Management errors occurred in 38% of the fatalities. There was a significantly higher percentage of management errors in small general hospitals (72%) than in large general (29%) and in university hospitals (34%). A (possibly or definitely) preventable cause of death was identified in 25% of the fatalities. There was a significantly higher preventable cause of death rate in small general hospitals than in both other hospital categories. Of all fatalities, 21% were classified as preventable deaths. A significantly higher preventable death rate occurred in small general hospitals (48%), than in large general (14%) and university hospitals (19%). From these results, it can be concluded that management errors and preventable deaths are general phenomena occurring in any hospital. However, they occur significantly more frequently in hospitals not especially equipped to manage severely injured patients.