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Title: Management deficiencies and death preventability of road traffic fatalities before and after a new trauma care system in Victoria, Australia.
Austin Authors: McDermott, Frank T;Cordner, Stephen M;Cooper, David James;Winship, Victoria C
Institutional Author: Consultative Committee on Road Traffic Fatalities in Victoria
Affiliation: Department of Surgery, Austin Health/Northern Health, The University of Melbourne, Heidelberg, Australia
Issue Date: 1-Aug-2007
Publication information: The Journal of Trauma; 63(2): 331-8
Abstract: The Consultative Committee's findings that preventable or potentially preventable (P/PP) death rates (survival prospects > or =25%) of road crash fatalities who received treatment were unaltered between 1992 and 1998 led to a Ministerial Taskforce on Trauma and the gradual introduction of a new Victorian trauma care system. The present study compares outcomes before (1997-1998) and after (2002-2004) the new system.The emergency and clinical management and death preventability of 245 consecutive fatalities in the 'before' period and 193 in the 'after' period was assessed by the committee's multidisciplinary panels using the complete hospital, ambulance, and autopsy findings.Emergency department admissions to expanded Major Trauma Services (MTS) increased from 34% to 62% (p < 0.05). More patients were attended by Advanced Trauma Life Support paramedics (p < 0.05) and scene times increased (p < 0.05). Patients admitted within 1 hour decreased from 70% to 45% (p < 0.05). The mean number of deficiencies per patient including those contributing to death was decreased (p < 0.05). The combined P/PP death rates decreased from 36% to 28% (22% relative risk reduction). The P/PP death rates for MTS, Metropolitan Trauma Services, Rural Trauma Services, and Urgent Care Centers for 2002 to 2004 were 25%, 33%, 50%, and 83%, respectively, and did not differ significantly from those of 1997 to 1998 (23%, 49%, 36%, 75%, respectively). The P/PP death rates in MTS were less than those of the other hospital groups.The new Victorian trauma care system has resulted in a significant decrease in deficiencies including those contributing to death and a decrease in P/PP deaths rates. The improvement has been largely consequent to a marked increase in admissions to MTS.
Gov't Doc #: 17693832
DOI: 10.1097/TA.0b013e31806dc5c4
Type: Journal Article
Subjects: Accidents, Traffic.mortality
Emergency Medical Services.organization & administration
Emergency Service, Hospital.organization & administration
Glasgow Coma Scale
Health Services Research
Hospital Mortality.trends
Injury Severity Score
Intensive Care.organization & administration
Middle Aged
Multiple Trauma.diagnosis.mortality.therapy
Needs Assessment
Outcome Assessment (Health Care)
Patient Care Team.organization & administration
Quality Assurance, Health Care
Regional Medical Programs.organization & administration
Survival Analysis
Trauma Centers.organization & administration
Appears in Collections:Journal articles

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