NORTH CAROLINA PREVENTABLE MORTALITY STUDY WITH INTER-RATER RELIABILITY MODIFICATIONS. DRAFT FINAL REPORT

A rural preventable mortality study was conducted in the 29 northeastern counties of rural North Carolina. The purpose of the study was to identify and prioritize problems in rural trauma care and to compare the results to a similar Montana study. The study method utilized an expert panel composed of trauma care providers from outside the region. The panel reviewed traumatic deaths utilizing a structural format. In addition, the reliability of the research process was assessed using a second independent panel to review half of the same cases. Of the 151 fatalities analyzed, 11 (7.3%) were judged to be preventable and 32 (21.2%) possibly preventable. The overall preventable death rate was 28.5%. Motor vehicle crashes were the most common cause of injury (37.7%) and gunshot wounds the second most common (18.5%). The majority of preventable deaths occurred either in a hospital emergency department or intensive care unit. Most of the preventable cases received inappropriate medical care. The most common prehospital care problem was inadequate airway management which was observed in 60 patients. The most common problem in hospital treatment involved delays resulting in a lengthy time until definitive care; there were 64 episodes of delays in hospital care. The total observed agreement between the two panels was 68% with a kappa of 0.37 making the inter-rater reliability fair. In contrast to the ECU study, the preventable death rate in the Montana study was 17%. Also in contrast to the ECU study, the majority of preventable deaths in the Montana study occurred in the prehospital phase. Although this study was limited by the relatively small numbers of cases analyzed, the results suggests that additional emphasis is needed in two specific areas: 1) the training of prehospital providers in airway management; and 2) the training of hospital providers in the importance of reducing the time to definitive care for the trauma patient. The preventable mortality study method could be of potential benefit in a "total quality management" approach at the state level.

  • Supplemental Notes:
    • Report Submission Date: July 31, 1995.
  • Corporate Authors:

    East Carolina University, Greenville

    School of Medicine, Department of Surgery - Trauma Service
    Greenville, NC  United States  27858

    National Highway Traffic Safety Administration

    1200 New Jersey Avenue, SE
    Washington, DC  United States  20590
  • Authors:
    • Cunningham, PRG
  • Publication Date: 1996-2

Language

  • English

Media Info

  • Features: Figures; References; Tables;
  • Pagination: 65 p.

Subject/Index Terms

Filing Info

  • Accession Number: 00723755
  • Record Type: Publication
  • Source Agency: National Highway Traffic Safety Administration
  • Report/Paper Numbers: HS-808 345
  • Contract Numbers: DTNH22-93-C-15140
  • Files: HSL, TRIS, USDOT
  • Created Date: Jul 3 1996 12:00AM