Assessment of Causes of Preventable Deaths in Pre-hospital Settings

Abstract

Objective: Death from trauma is a major problem for the health system. The determination of preventable deaths is a valuable indicator of quality and efficiency in the management of trauma patients. The purpose of our study was to investigate the cause of preventable death in pre-hospital settings in the city of Tabriz. Materials and Methods: In a cross-sectional study from 2013 to 2014 in Tabriz, all traumatic patients who died at the scene of trauma or during transport and before reaching the hospital were referred to forensics for autopsy studies. For all deaths, data on demographics, mechanism and type of injury, place of death, mode of transportation, injury to the central nervous system (CNS) and results of necropsy were recorded. Preventability of death was defined upon examination of the necropsy report. Results: In this study, 160 pre-hospital deaths were studied. The commonest mechanism of injury was a vehicular traffic accident (83.8%), and blunt trauma in 98.8% was the commonest type of injury. In total, 80.6% of the deaths were at the scene of trauma and 18.8% on arrival to the hospital. CNS injury was recorded in 71.9% of the cases. The commonest cause of death from the necropsy report was CNS injury (60.6%), exsanguination or breathing problems (28.1%), and CNS injury with exsanguination or breathing problems (11.2%). In this study, death was possibly preventable in 25.6% of the cases, and 21.9% of the deaths were definitively preventable. Conclusion: Many deaths occurred at the scene of trauma, and traffic accidents are the main mechanism of injury. A high percentage of deaths as seen in the autopsy had CNS injuries, and this was the main cause of death. The high rate of preventable death in the present study compared to that in similar studies in other countries is a significant finding.