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Published on: November 20, 2016
Independent factors of preventable death in a mature trauma center: a propensity-score analysis
Marion Robaix1, Quentin Mathais1, Hilaire de Malleray1
1Anaesthesiology and Intensive Care Department, Military Teaching Hospital Sainte Anne, Toulon, France.
Insights
Delays in trauma care and pelvic injuries significantly increase the risk of preventable death. Addressing pre-hospital and operating room delays is crucial for improving trauma patient outcomes and reducing mortality.
Area of Science:
- Trauma care research
- Mortality factor analysis
- Public health and emergency medicine
Background:
- Potentially preventable deaths (PPD) and preventable deaths (PD) constitute over 20% of trauma mortality.
- Hemorrhage is the primary cause of preventable mortality in trauma patients.
- Identifying independent factors for PD is essential for optimizing trauma care systems.
Purpose of the Study:
- To determine independent risk factors for preventable or potentially preventable mortality within a mature trauma system.
- To analyze specific delays and injury types associated with increased mortality risk.
Main Methods:
- A single-center retrospective study was conducted from January 2013 to December 2020.
- Severe trauma patients (survivors and those with PD) were included and matched using propensity scores.
- A generalized linear model identified independent factors for preventable mortality.
Main Results:
- After matching, 245 survivors and 49 patients in the PD group were analyzed.
- Significantly longer pre-hospital delays (73 min vs. 54 min) and operating room delays (80 min vs. 52 min) were observed in the PD group.
- Pelvic trauma was also identified as an independent factor for preventable mortality (OR 6.20).
Conclusions:
- Pre-hospital care delays are independently associated with increased preventable mortality risk.
- Delays in accessing the operating room post-trauma center arrival are critical factors in preventable deaths.
- Pelvic injuries represent a significant independent risk factor for preventable mortality in trauma patients.
Introduction:
The rate of potentially preventable deaths (PPD) and preventable deaths (PD) can reach more than 20% of overall trauma mortality. Bleeding is the leading cause of preventable mortality. The aim of our study is to define the independent factors of preventable or potentially preventable mortality in our mature trauma system.
Materials And Methods:
We conducted a single-center retrospective study in the Sainte Anne Military Teaching Hospital, Toulon, France, including all severe trauma patients admitted to our trauma center and discharged alive as well as all severe trauma patients who died with a death considered preventable or potentially preventable from January 2013 to December 2020. We matched the two groups using a propensity score and searched for independent factors using a generalized linear model.
Results:
846 patients were included and analyzed. After matching, our cohort consisted of 245 patients in the survivor group and 49 patients in the preventable deaths group. Pre-hospital delays (73 min vs 54 min P = 0.003) as well as delays before incision in the operating room (80 min vs 52 min P < 0.001) were significantly longer in the PD group. These delays were independent factors of preventable mortality OR 10.35 (95% CI [3.44-31.11] P < 0.001) and OR 37.53 (95% CI [8.51-165.46] P < 0.001) as well as pelvic trauma OR 6.20 (95% CI [1.53-25.20] P = 0.011).
Conclusion:
Delays in pre-hospital care, delays in access to the operating room from arrival at the trauma center, and pelvic injuries are independent factors associated with an increased risk of preventable mortality in trauma.
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