Evaluation of potentially preventable deaths among pedestrian and bicyclist fatalities
F. P. Rivara, R. V. Maier, B. A. Mueller, G. A. Luna, B. G. Dicker, C. M. Herman, J. W. Kenagy, M. K. Copass and C. J. Carrico
Harborview Injury Prevention and Research Center, Seattle, WA 98104.
The prehospital, emergency department, and in-hospital care of 84 patients
who died following a pedestrian- or bicycle-motor vehicle collision in a
four-county area was retrospectively reviewed using a systematic, detailed
scoring system. The purpose of the study was to examine the effectiveness
of an advanced paramedic-regionalized trauma care system and to examine the
usefulness of a systematic evaluation tool in identifying preventable and
possibly preventable deaths. Among the 84 deaths, one was judged to be
preventable and 18 possibly preventable. The one preventable death occurred
in the emergency department, while the possibly preventable deaths more
commonly occurred after 48 hours and were due to central nervous system
injury, sepsis, and multiple organ failure. Prolonged prehospital and
emergency department time and failure to establish an airway were the most
common problems identified as contributing to fatal outcome. The use of
explicit criteria was demonstrated to be an effective addition to the
analysis of trauma care systems.