Objective: To evaluate the management of severe trauma in intensive care, h
igh dependency and general surgical wards of Victorian hospitals.
Design: Retrospective case review by multidisciplinary committees.
Subjects: The first 256 people who died from road traffic accidents who wer
e alive on the arrival of emergency services between 1 July 1992 and 30 Jun
e 1994.
Main outcome measures: (1) Severity of injury according to clinical diagnos
is, autopsy findings and recognised trauma-scoring methods; (2) errors in m
anagement, identified as contributing or not contributing to the cause of d
eath, and categorised as "management", "system", "diagnostic" or "technique
" errors;
Result-Most patients (61%) were admitted to an intensive care unit (ICU), a
nd 19.5% were admitted to high dependency or general surgical wards. Of 218
7 errors of care identified, 11.8% occurred in ICU and 6.7% in wards,with t
he remainder occurring during the earlier phases of care. Most errors were
classified as management errors (82% of ICU errors and 88% of ward errors).
Fifty-two per cent of ICU errors and 71% of ward errors were judged to con
tribute to the patient's death.
Conclusions: A significant number of errors of trauma management occur in t
he intensive care and general surgical ward. Improvement in late trauma car
e may reduce the number of preventable trauma deaths.