A STUDY OF PREVENTABLE TRAUMA MORTALITY IN RURAL MICHIGAN

Objective: To determine the preventable death rate (PDR) and the frequ ency and types of inappropriate medical care in a large, rural region of Michigan. Design: A prospective study of all deaths caused by injur y during a 1-year period. Methods: Preventability of death and appropr iateness of care were determined using a structured implicit review pr ocess and expert panel. A second panel was convened to confirm the rel iability of the review process. Main Results: One hundred fifty-five i njury-related deaths underwent panel review. Four deaths (2.6%) were f ound to be definitely preventable and 16 (10.3%) possibly preventable, for a combined preventable death rate of 12.9%, Sixty-five deaths (41 .9%) occurred in the emergency department or hospital; 18 of these (27 .7%) were judged to be definitely preventable or possibly preventable. Forty-three episodes of inappropriate care were identified in 27 (17. 4%) of the 155 cases reviewed. These occurred primarily in the emergen cy department and hospital rather than during prehospital care or tran sfer, Conclusions: A relatively small percentage of trauma fatalities in rural Michigan could have been prevented by more appropriate or tim ely medical care, Efforts to improve the care of injured persons in ru ral Michigan should be directed primarily at the emergency department and inpatient phases of trauma system care.