QUALITY ASSESSMENT OF THE MANAGEMENT OF ROAD TRAFFIC FATALITIES AT A LEVEL-I TRAUMA CENTER COMPARED WITH OTHER HOSPITALS IN VICTORIA, AUSTRALIA

Objectives: Since 1992, the Consultative Committee on Road Traffic Fat alities in Victoria, Australia, has identified problems including thos e contributing to death and the potential preventability of deaths in road fatalities who survived until at least the arrival of ambulance s ervices. The present analysis examines the outcomes at a Level I traum a center compared with other hospital groups in Victoria. Methods: Bet ween 1992 and 1994, 257 consecutive eligible fatalities were evaluated . Problems in management and preventable deaths were identified at the trauma center (TC) and in pooled data from other hospital groups, i.e ., specialist teaching (Level II), other metropolitan (Level III), lar ge regional (Level III), and small regional hospitals. Results: Mean p roblems identified and those contributing to death (controlled for the number of areas of care), were less frequent at TC (1.7 and 0.6) than at other hospital groups (specialist teaching, 1.9 and 1.1; metropol itan, 3.1 and 1.6*; large regional, 3.8* and 1.8*; small regional, 5. 1 and 2.6*) (*p < 0.05 compared with TC). Preventable and potentially preventable deaths were also less common at TC (20%) than at the othe r hospital groups (specialist teaching, 40%; metropolitan, 41%*; larg e regional, 53%; small regional, 62%*) (*p < 0.05 compared with TC). When a Trauma and Injury Severity Score of 75% or more was used to def ine preventable death, a similar trend was Identified. Conclusion: Man agement of patients with major trauma at a Level I trauma center was a ssociated with fewer problems contributing to death and fewer preventa ble and potentially preventable deaths than at the different hospital groups. A trauma system in Victoria, including bypass of major trauma patients to designated hospitals with 24-hour trauma services, is like ly to decrease the frequency of problems, including the preventable de ath rates.