Preventable Trauma Deaths after Traffic Accidents in Chiba Prefecture, Japan, 2011: Problems and Solutions

被引:17
作者
Motomura, Tomokazu [1 ]
Mashiko, Kunihiro [1 ]
Matsumoto, Hisashi [1 ]
Motomura, Ayumi [2 ]
Iwase, Hirotaro [2 ]
Oda, Shigeto [3 ]
Shimamura, Fumihiko [4 ]
Shoko, Tomohisa [5 ]
Kitamura, Nobuya [6 ]
Sakaida, Koji [7 ]
Fukumoto, Yuichi [8 ]
Kasuya, Miyuki [9 ]
Koyama, Tsutomu [10 ]
Yokota, Hiroyuki [11 ]
机构
[1] Chiba Hokusoh Hosp, Nippon Med Sch, Shock & Trauma Ctr, Inzai, Chiba 2701694, Japan
[2] Chiba Univ, Grad Sch Med, Dept Legal Med, Chiba, Japan
[3] Chiba Univ, Grad Sch Med, Dept Emergency & Crit Care Med, Chiba, Japan
[4] Chiba Emergency Med Ctr, Chiba, Japan
[5] Matsudo City Hosp, Trauma & Crit Care Ctr, Matsudo, Chiba, Japan
[6] Kimitsu Chuo Hosp, Dept Emergency & Crit Care Med, Kisarazu, Chiba, Japan
[7] Funabashi Municipal Med Ctr, Funabashi, Chiba, Japan
[8] Juntendo Univ, Urayasu Hosp, Urayasu, Chiba, Japan
[9] Asahi Gen Hosp, Chiba, Japan
[10] Jikei Univ, Sch Med, Kashiwa Hosp, Dept Emergency Med, Tokyo, Japan
[11] Nippon Med Sch, Dept Emergency & Crit Care Med, Tokyo, Japan
关键词
preventable trauma death; traffic accident; peer review; trauma center; SYSTEM;
D O I
10.1272/jnms.81.320
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: The incidence of preventable trauma death in the current Japanese emergency medical system remains high. The present study aimed to determine rates of clearly preventable and possibly preventable trauma deaths due to traffic accidents in Chiba Prefecture, Japan, and to consider associated problems and solutions. Materials and Methods: During 2011, 175 victims died after traffic accidents in Chiba Prefecture. Of these, the deaths of 69 persons who had vital signs at the time of emergency medical service contact were classified as clearly preventable, possibly preventable, or not preventable through the peer review discussion. We also examined problems associated with deaths that were clearly preventable or possibly preventable. Results: Of the 69 deaths, 9 (13%) were classified as clearly preventable, 11 (16%) as possibly preventable, and 49 (71%) as not preventable. Of the 20 clearly or possibly preventable deaths (each death potentially comprising multiple problems), 5 were related to selection of the hospital before hospital arrival, 4 to problems with regional emergency medical systems, and 15 to inappropriate hemodynamic management, including transfusion and delayed (or not attempted) hemostasis in the hospital. Discussion: Problems of these 20 deaths showed that appropriate triage at the scene, centralization of patients with severe trauma, and trauma centers are necessary in Japan. Under-triage before arrival at the hospital was related to clearly and possibly preventable deaths. Upgrading the triage category for victims with torso injury must be considered. Not all emergency critical care centers in Japan are able to provide severe trauma care. Preventable trauma deaths occur even in some emergency critical care centers; therefore, we need centralization of severe trauma patients from wider area to reduce the incidence of preventable trauma death.
引用
收藏
页码:320 / 327
页数:8
相关论文
共 11 条
[1]  
[Anonymous], 2011, REP CHIB TRAFF ACC I, P4
[2]  
Champion H R, 2002, Scand J Surg, V91, P12
[3]  
Champion HR, NEW TOOLS REDUCE DEA, V05-0191
[4]   ECONOMICAL AND PROVED HELICOPTER PROGRAM FOR TRANSPORTING EMERGENCY CRITICALLY ILL AND INJURED PATIENT IN MARYLAND [J].
COWLEY, RA ;
HUDSON, F ;
SCANLAN, E ;
GILL, W ;
LALLY, RJ ;
LONG, W ;
KUHN, AO .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 1973, 13 (12) :1029-1038
[5]   Effect of a voluntary trauma system on preventable death and inappropriate care in a rural state [J].
Esposito, TJ ;
Sanddal, TL ;
Reynolds, SA ;
Sanddal, ND .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2003, 54 (04) :663-669
[6]   Relationship between trauma center volume and outcomes [J].
Nathens, AB ;
Jurkovich, GJ ;
Maier, RV ;
Grossman, DC ;
MacKenzie, EJ ;
Moore, M ;
Rivara, FP .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 285 (09) :1164-1171
[7]  
Rogers FB, 1997, ARCH SURG-CHICAGO, V132, P376
[8]   Analysis of Preventable Trauma Deaths and Opportunities for Trauma Care Improvement in Utah [J].
Sanddal, Teri L. ;
Esposito, Thomas J. ;
Whitney, Jolene R. ;
Hartford, Diane ;
Taillac, Peter P. ;
Mann, N. Clay ;
Sanddal, Nels D. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2011, 70 (04) :970-977
[9]  
Takayanagi K, 1998, Clin Perform Qual Health Care, V6, P163
[10]   Preventable or potentially preventable mortality at a mature trauma center [J].
Teixeira, Pedro G. R. ;
Inaba, Kenji ;
Hadjizacharia, Pantelis ;
Brown, Carlos ;
Salim, Ali ;
Rhee, Peter ;
Browder, Timothy ;
Noguchi, Thomas T. ;
Demetriades, Demetrios .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2007, 63 (06) :1338-1346