Esposito, T. J., Sanddal, N. D., Hansen, J. D., & Reynolds, S.
(1995) Analysis of preventable trauma deaths and inappropriate trauma
care in a rural state. J Trauma, 39 (5), 955-62.
OBJECTIVE: The goal of this study was to determine the rate of
preventable mortality and inappropriate care in cases of traumatic death
occurring in a rural state.
DESIGN: This is a retrospective case review.
MATERIALS AND METHODS: Deaths attributed to mechanical trauma
throughout the state and occurring between October 1, 1990 and September
30, 1991 were examined. All cases meeting inclusion criteria were
reviewed by a multidisciplinary panel of physicians and nonphysicians
representing the prehospital as well as hospital phases of care. Deaths
were judged frankly preventable, possibly preventable, or
nonpreventable. The care rendered in both preventable and nonpreventable
cases was evaluated for appropriateness according to nationally accepted
MEASUREMENTS AND MAIN RESULTS: The overall preventable death rate was
13%. Among those patients treated at a hospital, the preventable death
rate was 27%. The rate of inappropriate care was 33% overall and 60%
in-hospital. The majority of inappropriate care occurred in the
emergency department phase and was rendered by one or more members of
the resuscitation team, including primary contact physicians and
surgeons. Deficiencies were predominantly related to the management of
the airway and chest injuries.
CONCLUSIONS: The rural preventable death rate from trauma is not
dissimilar to that found in urban areas before the implementation of a
trauma care system. Inappropriate care rendered in the emergency
department related to airway and chest injury management occurs at a
high rate. This seems to be the major contributor to preventable trauma
deaths in rural locations. Education of emergency department primary
care providers in basic principles of stabilization and initial
treatment may be the most cost-effective method of reducing preventable
deaths in the rural setting.