Top

World Journal of Surgery

Published in:

01-07-2014

Minimizing Preventable Trauma Deaths in a Limited-Resource Setting: A Test-Case of a Multidisciplinary Panel Review Approach at the Komfo Anokye Teaching Hospital in Ghana

Authors: Dominic Yeboah, Charles Mock, Patrick Karikari, Peter Agyei-Baffour, Peter Donkor, Beth Ebel

Published in: World Journal of Surgery | Issue 7/2014

Abstract

Objective

Our objectives were to determine the proportion of preventable trauma deaths at a large trauma hospital in Kumasi, Ghana, and to identify opportunities for the improvement of trauma care.

Methods

A multidisciplinary panel of experts evaluated pre-hospital, hospital, and postmortem data of consecutive trauma patients who died over a 5-month period in 2006–2007 at the Komfo Anokye Teaching Hospital. The panel judged the preventability of each death. For preventable and potentially preventable deaths, deficiencies in care that contributed to their deaths were identified.

Results

The panel reviewed 231 trauma deaths. Of these, 84 charts had sufficient information to review preventable factors. The panel determined that 23 % of trauma deaths were definitely preventable, 37 % were potentially preventable, and 40 % were not preventable. One main deficiency in care was identified for each of the 50 definitely preventable and potentially preventable deaths. The most common deficiencies were pre-hospital delays (44 % of the 50 deficiencies), delay in treatment (32 %), and inadequate fluid resuscitation (22 %). Among the 19 definitely preventable deaths, the most common cause of death was hemorrhage (47 %), and the most common deficiencies were inadequate fluid resuscitation (37 % of deficiencies in this group) and pre-hospital delay (37 %).

Conclusions

A high proportion of trauma fatalities might have been preventable by decreasing pre-hospital delays, adequate resuscitation in hospital, and earlier initiation of care, including definitive surgical management. The study also showed that preventable death panel reviews are a feasible and useful quality improvement method in the study setting.

Murray CJ, Vos T, Lozano R et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197–2223PubMedCrossRef

World Health Organization (2010) Injuries and violence: the facts. WHO, Geneva. http://www.who.int/violence_injury_prevention/key_facts/en/index.html. Accessed 20 Jan 2012

Lozano R, Naghavi M, Foreman K (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2095–2128PubMedCrossRef

London JA, Mock CN, Quansah RE, Abantanga FA (2001) Priorities for improving hospital based trauma care in an African city. J Trauma 51:747–753PubMedCrossRef

Mock C, Joshipura M, Arreola-Risa C, Quansah R (2012) An estimate of the number of lives that could be saved through improvements in trauma care globally. World J Surg 36:959–963. doi:10.1007/s00268-012-1553-9 PubMedCrossRef

Zafarghandi M, Modaghegh M, Roudsari B (2003) Preventable trauma death in Tehran: an estimate of trauma care quality in teaching hospitals. J Trauma 55:459–465PubMedCrossRef

Mock C, Juillard C, Brundage S, Goosen J, Joshipura M (eds) (2009) Guidelines for trauma quality improvement programmes. WHO, Geneva

Cales RH (1984) Trauma mortality in Orange Country: the effect of implementation of a regional trauma system. Ann Emerg Med 13:1–10PubMedCrossRef

Esposito TJ, Sanddal TL, Reynolds SA, Sanddal ND (2003) Effect of a voluntary trauma system on preventable death and inappropriate care in a rural state. J Trauma 54:663–669PubMedCrossRef

10.

Gruen RL, Jurkovich GJ, McIntyre LK, Foy HM, Maier RV (2006) Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg 244(3):371–380PubMedCentralPubMed

11.

O’Reilly D, Mahendran K, West A, Shirley P, Walsh M, Tai N (2013) Opportunities for improvement in the management of patients who die from haemorrhage after trauma. Br J Surg 100(6):749–755PubMedCrossRef

12.

Stocchetti N, Pagliarini G, Gennari M et al (1994) Trauma care in Italy: evidence of in-hospital preventable deaths. J Trauma 36(3):401–405PubMedCrossRef

13.

Juillard C, Mock C, Goosen J, Joshipura M, Civil I (2009) Establishing the evidence base for trauma quality improvement programs: a collaborative WHO-IATSIC review. World J Surg 33:1075–1086. doi:10.1007/s00268-009-9959-8 PubMedCrossRef

14.

Peabody JW, Taguiwalo MM, Robalino DA, Frenk J (2006) Improving the quality of care in developing countries. In: Jamison DT, Breman J, Measham AR et al (eds) Disease control priorities in developing countries, 2nd edn. Oxford University Press for the World Bank, Oxford, pp 1293–1307

15.

Cales RH, Trunkey DD (1985) Preventable trauma deaths. A review of trauma care systems development. JAMA 254(8):1059–1063PubMedCrossRef

16.

Chiara O, Scott JD, Cimbanassi S et al (2002) Trauma deaths in an Italian urban area: an audit of pre-hospital and in-hospital trauma care. Injury 33:553–562PubMedCrossRef

17.

Esposito TJ, Sandall ND, Dean JM, Hansen JD, Reynolds SA, Battan K (1999) Analysis of preventable pediatric trauma deaths and inappropriate trauma care in Montana. J Trauma 47:243–251PubMedCrossRef

18.

Kleber C, Giesecke MT, Tsokos M, Haas NP, Buschmann CT (2013) Trauma-related preventable deaths in Berlin 2010: need to change prehospital management strategies and trauma management education. World J Surg 37(5):1154–1161. doi:10.1007/s00268-013-1964-2 PubMedCrossRef

19.

Maio RF, Burney RE, Gregor MA, Baranski MG (1996) A study of preventable trauma mortality in rural Michigan. J Trauma 41:83–90PubMedCrossRef

20.

Saltzherr TP, Wendt KW, Nieboer P et al (2011) Preventability of trauma deaths in a Dutch level-1 trauma centre. Injury 42:870–873PubMedCrossRef

21.

Sanddal TL, Esposito TJ, Whitney JR et al (2011) Analysis of preventable trauma deaths and opportunities for trauma care improvement in Utah. J Trauma 70:970–979PubMedCrossRef

22.

West J (1981) An autopsy method for evaluating trauma care. J Trauma 21:32–34PubMedCrossRef

23.

West JG, Cales RH, Gazzaniga AB (1983) Impact of regionalization. The Orange County experience. Arch Surg 118(6):740–744PubMedCrossRef

24.

West JG, Trunkey DD, Lim RC (1979) Systems of trauma care: a study of two counties. Arch Surg 114(4):455–460PubMedCrossRef

25.

Afuwape OO, Okolo CA, Akinyemi OA (2011) Preventable trauma deaths in Ibadan: a comparison of revised trauma score and panel review. West Afr J Med 30:19–23PubMed

26.

Jat A, Khan M, Zafar H et al (2004) Peer review audit of trauma deaths in a developing country. Asian J Surg 27:58–64PubMedCrossRef

27.

MacKenzie EJ, Steinwachs DM, Bone LR, Floccare DJ, Ramzy AI (1992) Inter-rater reliability of preventable death judgments. The Preventable Death Study Group. J Trauma 33(2):292–302 discussion 302-293PubMedCrossRef

28.

Husum H, Gilbert M, Wisborg T, Heng YV, Murad M (2003) Rural prehospital trauma systems improve trauma outcome in low-income countries: a prospective study from North Iraq and Cambodia. J Trauma 54:1188–1196PubMedCrossRef

29.

Mock C, Juillard C, Joshipura M, Goosen J (eds) (2010) Strengthening care for the injured: success stories and lessons learned from around the world. WHO, Geneva

30.

Sasser S, Varghese M, Kellermann A, Lormand J (2005) Prehospital trauma care systems. WHO, Geneva

31.

Tiska M, Aduo-Ampofo M, Boakye G, Tuuli L, Mock C (2004) The quality of prehospital trauma care reported by commercial drivers in Africa after rescue training. Emerg Med J 21:237–239PubMedCentralPubMedCrossRef

32.

Wisborg T, Murad M, Edvardsen O, Husum H (2008) Prehospital trauma system in a low-income country: system maturation and adaptation during 8 years. J Trauma 64:1342–1348PubMedCrossRef

Title: Minimizing Preventable Trauma Deaths in a Limited-Resource Setting: A Test-Case of a Multidisciplinary Panel Review Approach at the Komfo Anokye Teaching Hospital in Ghana
Authors: Dominic Yeboah
Charles Mock
Patrick Karikari
Peter Agyei-Baffour
Peter Donkor
Beth Ebel
Publication date: 01-07-2014
Publisher: Springer US
Published in: World Journal of Surgery / Issue 7/2014
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-014-2452-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Minimizing Preventable Trauma Deaths in a Limited-Resource Setting: A Test-Case of a Multidisciplinary Panel Review Approach at the Komfo Anokye Teaching Hospital in Ghana

Abstract

Objective

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 7/2014

Understanding the Burden and Outcome of Trauma Care Drives a New Trauma Systems Model

Transdiaphragmatic Resuscitative Open Cardiac Massage: Description of the Technique and a First Case-Series of an Alternative Approach to the Heart

Ethical Issues of Expert Witness Testimony

Pathological Confirmation of Para-Aortic Lymph Node Status as a Potential Criterion for the Selection of Intrahepatic Cholangiocarcinoma Patients for Radical Resection with Regional Lymph Node Dissection

Elements for Adequate Informed Consent in the Surgical Context

Copy Number Variation in CCND1 Gene Is Implicated in the Pathogenesis of Sporadic Parathyroid Carcinoma