ANALYSIS OF PREVENTABLE TRAUMA DEATHS AND INAPPROPRIATE TRAUMA DARE IN A RURAL STATE

Objective: The goal of this study was to determine the rate of prevent able mortality and inappropriate care in cases of traumatic death occu rring in a rural state, Design: This is a retrospective case review, M aterials and Methods: Deaths attributed to mechanical trauma throughou t the state and occurring between October 1, 1990 and September 30, 19 91 were examined, All cases meeting inclusion criteria were reviewed b y a multidisciplinary panel of physicians and nonphysicians representi ng the prehospital as well as hospital phases of care. Deaths were jud ged frankly preventable, possibly preventable, or nonpreventable. The care rendered in both preventable and nonpreventable cases was evaluat ed for appropriateness according to nationally accepted guidelines, Me asurements and Main Results: The overall preventable death rate was 13 %, Among those patients treated at a hospital, the preventable death r ate was 27%, The rate of inappropriate care was 33% overall and 60% in -hospital, The majority of inappropriate care occurred in the emergenc y department phase and was rendered by one or more members of the resu scitation team, including primary contact physicians and surgeons. Def iciencies were predominantly related to the management of the airway a nd chest injuries, Conclusions: The rural preventable death rate from trauma is not dissimilar to that found in urban areas before the imple mentation of a trauma care system, Inappropriate care rendered in the emergency department related to airway and chest injury management occ urs at a high rate, This seems to be the major contributor to preventa ble trauma deaths in rural locations, Education of emergency departmen t primary care providers in basic principles of stabilization and init ial treatment may be the most cost-effective method of reducing preven table deaths in the rural setting.