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Classification of trauma-related preventable death; a Delphi procedure in The Netherlands
N A G Hakkenbrak1, A M K Harmsen2, W P Zuidema2
1Trauma Unit, Department of Surgery, Amsterdam University Medical Centre, the Netherlands; Trauma Unit, Department of Surgery, Northwest Clinics, Alkmaar, the Netherlands.
Injury
|May 24, 2025
Summary
Defining trauma-related preventable death is crucial for evaluating trauma care quality. Experts leaned towards a combined clinical definition and trauma prediction algorithm, specifically TRISS with Probability of Survival, to improve accuracy.
Area of Science:
- Trauma Care Research
- Medical Quality Improvement
- Predictive Analytics in Medicine
Background:
- Trauma-related preventable death is a key metric for assessing trauma care quality globally.
- A standardized definition for trauma-related preventable death is currently lacking, hindering consistent evaluation.
- A Delphi procedure was initiated to establish a consensus definition and evaluate the need for a trauma prediction algorithm.
Purpose of the Study:
- To achieve multidisciplinary consensus on a definition for trauma-related preventable death.
- To assess the necessity and benefit of incorporating a trauma prediction algorithm into the definition.
- To identify the most suitable trauma prediction algorithm for use in trauma care evaluation.
Main Methods:
- A three-round digital Delphi procedure involving trauma care specialists from Dutch Level 1 trauma centers.
- Participants included trauma surgeons, neurosurgeons, forensic medicine physicians, anesthesiologists, and emergency care physicians.
- An electronic questionnaire was used to gather expert opinions on definitions and prediction algorithms.
Main Results:
- Fifty-four panelists completed the study, representing diverse trauma care specialties.
- Initial rounds favored a clinical definition, with a growing preference for a combined clinical definition and trauma prediction algorithm.
- A majority (63%) leaned towards consensus on a combined approach, with agreement on using the Trauma Score and Injury Severity Score (TRISS) combined with Probability of Survival (PS) as the optimal algorithm.
Conclusions:
- Establishing a clear definition for trauma-related preventable death is vital for trauma care evaluation.
- Achieving multidisciplinary consensus on this definition presents challenges.
- There is a discernible trend towards agreement on a clinical definition and recognition of the added value of the TRISS combined with PS for predicting survival.
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