Problems of Trauma Care and Rate of Preventable Trauma Death in Jeju, South Korea

ABSTRACT

PURPOSE: This study was undertaken to investigate preventable trauma death and trauma care errors contributing to death on Jeju Island. METHODS: A retrospective study was conducted on all trauma deaths between January 2008 and May 2010 at five emergency departments (ED) in Jeju. Of the 165 deaths, 101 patients included for study after excluding death within one hour or after one week. Injury severity was scored according to the Injury Severity Score (ISS) and survival probability (Ps) was calculated. Trauma care errors were coded to six categories pre-hospital, ED, operating room, intensive care unit, general ward, and inter-hospital transfer. In addition, system inadequacy, problems in treatment, diagnosis, and procedures were analyzed. Patient records were reviewed independently and preventability was determined by agreement. RESULTS: The preventable death rate was 35.6%, and the mean ISS was 25.25+/-10.78. Of all 149 inappropriate cares, 66.4% contributed to death. Of the 121 treatment-related problems, 88 problems occurred in the ED. Of the 18 system-related problems, 12 were in the pre-hospital phase. Seventy of the 96 problems associated with deaths occurred in the ED, and 12 of 29 problems in the pre-hospital phase. CONCLUSION: The preventable death rate was high. Inappropriate care rendered in the treatment process in the ED and system-related errors in the pre-hospital phase were major contributors to preventable trauma deaths. To reduce preventable deaths, more efforts are required on organizing trauma team management and improving care errors during the pre-hospital and inter-hospital transfer.