Comparison of Military and Civilian Methods for Determining Potentially Preventable Deaths: A Systematic Review

Area of Science:

• Trauma care systems
• Medical quality improvement
• Public health surveillance

Background:

• Military and civilian trauma experts collaborated to create an integrated learning trauma system.
• The Department of Defense lacks standardized guidelines for military preventable death reviews.
• Developing consistent performance improvement processes is essential to reduce preventable morbidity and mortality.

Purpose of the Study:

• To compare military and civilian preventable death determination methods.
• To identify best practices for evaluating preventable deaths.

Main Methods:

• A systematic review following PRISMA guidelines was conducted.
• Searched multiple databases (MEDLINE, PubMed, CINAHL, etc.) for English-language articles from inception to February 15, 2017.
• Included studies reviewing prehospital, inhospital, or both types of deaths; abstracted data on study characteristics and preventable death rates.

Main Results:

• Fifty studies (8 military, 42 civilian) met inclusion criteria.
• Potentially preventable deaths: 1598/6500 military (3.1%-51.4% rate) and 3346/19108 civilian (2.5%-85.3% rate).
• High methodological heterogeneity in definitions, review processes, and criteria limited quantitative comparison.

Conclusions:

• Inconsistent definitions and heterogeneous methods impair the reliability of military and civilian preventable death studies.
• Combat's complexity necessitates unique considerations for sound combat-related preventable death reviews.
• The Department of Defense must consider factors increasing bias and poor reliability when developing new guidelines.