||Pediatric Preventable Mortality
Esposito, T. J., Sanddal, N. D., Dean, J. M., Hansen, J. D., Reynolds,
S. A. Battan, K. (1999). Analysis of preventable pediatric trauma deaths
and inappropriate trauma care in Montana. J Trauma 47(2):243-253.
OBJECTIVE: To determine the rates of preventable mortality and
inappropriate care, as well as the nature of treatment errors associated
with pediatric traumatic deaths occurring in Montana.
METHODS: Retrospective multidisciplinary consensus panel review of
deaths attributed to mechanical trauma in children aged 18 years or
less, occurring in Montana between October 1, 1989, and September 30,
1992. The care rendered in both preventable and nonpreventable cases was
evaluated for appropriateness according to nationally accepted
guidelines. Rates of pediatric preventable death and inappropriate care,
as well as the nautre of inappropriate care, were compared with that of
the adult population.
RESULTS: One hundred thirty-eight cases were reviewed. One death
(less than 1%) was judged frankly preventable, 11 deaths (8%) were
judged possibly preventable, giving a total preventability rate of 9%
for all cases reviewed. Considering only in-hospital deaths (n=77), the
total preventability rate was 16% The rate of inappropriate care
rendered for all deaths, regardless of preventability, was 36%. The rate
of inappropriate care in the prehospital phase was 16%; for in-hospital
deaths, it was 47%. In the emergency department (ED), the rate was 36%,
and in post-Ed care, 22%. In comparison to the adult population, the
rates of preventable death (9% vs. 14%) and inappropriate care in the
hospital phase (64% vs. 66%) were lower. Inappropriate care for the
pediatric group was more prevalent in patients less than or equal to 14
years old. The nature of inappropriate care was most frequently
associated with the management of respiratory problems, including airway
control and management of chest trauma.
CONCLUSION: Preventable mortality from traumatic injuries in children
in rural states appears to be low, and lower than that reported for
adult trauma victims in the same state. A preponderance of these
preventable deaths occurs in the subgroup of children less than or equal
to 15 years of age. Inappropriate trauma care in children occurs
frequently, particularly in the ED phase of care, and is primarily
associated with the management of the airway and chest injuries.
Education of ED primary care providers in basic principles of
stabilization and initial treatment of the injured child 15 years old or
younger may be the most effective method of reducing preventable trauma
deaths in the rural setting.