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.