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Preventable death in trauma: A systematic review on definition and classification
N A G Hakkenbrak1, S Y Mikdad1, W P Zuidema2
1Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands; Department of Trauma surgery, Amsterdam University Medical Centre, location VU medical centre, Amsterdam, the Netherlands.
The definition of trauma-related preventable death (TRPD) lacks validity. This review recommends a standardized TRPD definition using clinical assessment and trauma prediction algorithms for improved trauma care quality evaluation.
Area of Science:
- Trauma Care
- Medical Quality Assessment
- Systematic Review
Background:
- Trauma-related preventable death (TRPD) is a global metric for assessing trauma care quality.
- Current TRPD definitions lack standardization and validity due to varied terminology and application.
- A clear, consistent definition is needed to accurately evaluate trauma management worldwide.
Purpose of the Study:
- To systematically review existing literature on trauma-related preventable death.
- To identify current methodologies for defining and assessing TRPD.
- To establish a designated definition for TRPD to enhance trauma care quality assessment.
Main Methods:
- Conducted a systematic literature search across PubMed, Embase, Cochrane Library, and Web of Science.
- Included studies published between January 1, 1990, and April 6, 2021, focusing on TRPD.
- Assessed studies based on their TRPD definition, injury severity scoring tools, and panel review composition.
Main Results:
- Analyzed 68 selected articles from 3,614 identified.
- TRPD definitions were categorized into clinical, algorithmic, combined, or other.
- Nearly 85% of studies utilized clinical definitions, often supplemented by algorithms like ISS and TRISS. Panels frequently included trauma surgeons and other specialists.
Conclusions:
- The current literature lacks an unambiguous definition for TRPD.
- A standardized TRPD definition should integrate clinical assessment with trauma prediction algorithms, such as TRISS.
- TRPD review panels should comprise a multidisciplinary team including trauma surgeons, anesthesiologists, emergency physicians, neurologists, and forensic pathologists.
