Using an expert panel, we conducted a prospective study of all deaths due to injury occurring in 24 non-MSA counties to determine the preventable death rate (PDR) and to identify the frequency and nature of inappropriate medical care associated with those deaths. Panel review was conducted using a structured implicit review format. A second panel was also convened to determine the reliability of the review process. One hundred fifty-five deaths were analyzed. Ninety patients were pronounced dead at the scene and 65 patients were transported to a hospital. Twenty patients were identified as having definitely preventable or possibly preventable deaths for an overall PDR of 12.90%. For patients transported to a hospital the PDR was 27.69%. Motor vehicle crashes were the most common mechanism of injury overall and also among preventable deaths. Overall, the most frequent physiologic cause of death was central nervous system injury. Among preventable deaths, death from hemorrhage was most frequent. There were a total of 43 episodes of inappropriate care with 31 episodes occurring among preventable deaths. Among episodes of inappropriate care associated with preventable death, 12 occurred in the ED phase, 12 occurred in the in-hospital phase and 7 in the prehospital phase. Among preventable deaths the three most frequent types of inappropriate care were delays in treatment and/or evaluation (14), airway/ventilation management (7) and fluid/blood replacement (5). The second panel reviewed 75 cases. Inter-Panel agreement, as measured by Kappa was good (0.600). Only a relatively small percentage of rural trauma fatalities could have been saved by more appropriate or timely medical care. Current efforts to reduce this percentage should be primarily directed at care in the ED and in-hospital care and secondarily at prehospital care. Additional studies are warranted to determine the cause for inappropriate care being rendered. Further studies should also evaluate the manner by which resources need to be distributed between primary injury prevention and acute trauma care in order to most efficiently decrease rural trauma mortality.

  • Corporate Authors:

    University of Michigan Medical Center

    Emergency Medicine Section, 1500 E Medical Center Drive
    Ann Arbor, MI  United States  48109-0303

    National Highway Traffic Safety Administration

    1200 New Jersey Avenue, SE
    Washington, DC  United States  20590
  • Authors:
    • Maio, R F
    • Burney, R E
    • GREGOR, M A
    • Baranski, M G
    • Welch, K B
    • Rothman, E D
  • Publication Date: 1995-6


  • English

Media Info

  • Features: Appendices; Figures; References; Tables;
  • Pagination: 96 p.

Subject/Index Terms

Filing Info

  • Accession Number: 00723751
  • Record Type: Publication
  • Source Agency: National Highway Traffic Safety Administration
  • Report/Paper Numbers: HS-808 341
  • Contract Numbers: DTNH22-93-C-05410
  • Files: HSL, TRIS, USDOT
  • Created Date: Jul 2 1996 12:00AM