Analysis of preventable pediatric trauma deaths and inappropriate trauma care in Montana

Objective: To determine the rates of preventable mortality and inappropriat e care, as well as the nature of treatment errors associated with pediatric traumatic deaths occurring in a rural state. Methods: Retrospective multidisciplinary consensus panel review of deaths a ttributed to mechanical trauma in children aged 18 years or less, occurring in Montana between October 1, 1989, and September 30, 1992, The care rende red in both preventable and nonpreventable cases was evaluated for appropri ateness according to nationally accepted guidelines. Rates of pediatric pre ventable death and inappropriate care, as well as the nature of inappropria te 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 pr eventable, giving a total preventability rate of 9% for all cases reviewed. Considering only in-hospital deaths (n = 77), the total preventability rat e was 16%. The rate of inappropriate care rendered for all deaths, regardle ss of preventability, was 36%. The rate of inappropriate care in the prehos pital phase was 16%; for in-hospital deaths, it was 47%. In the emergency d epartment (ED), the rate was 36%, and in post-ED care, 22%. In comparison t o the adult population, the rates of preventable death (9% vs. 14%) and ina ppropriate care in the hospital phase (64% vs, 66%) were lower. Inappropria te care for the pediatric group was more prevalent in patients less than or equal to 14 Sears old. The nature of inappropriate care was most frequentl y associated with the management of respiratory problems, including airway control and management of chest trauma. Conclusion: Preventable mortality from traumatic injuries in children in a rural state appears to be low, and lower than that reported for adult traum a victims in the same state. Zi preponderance of these preventable deaths o ccur in the subgroup of children less than or equal to 14 years if age, Ina ppropriate trauma care in children occurs frequently, particularly in the E D phase of care, and is primarily associated with the management of the air way and chest injuries. Education of ED primary care providers in basic pri nciples of stabilization and initial treatment of the injured child 14 gear s old or younger may be the most effective method of reducing preventable t rauma deaths in the rural setting.