Peer review audit of trauma deaths in a developing country.
ABSTRACT Peer review of trauma deaths can be used to evaluate the efficacy of trauma systems. The objective of this study was to estimate teh proportion of preventable trauma deaths and the factors contributing to poor outcome using peer review in a tertiary care hospital in a developing country.
All trauma deaths during a 2-year period (1 January 1998 to 30 December 1998) were identified and registered in a computerized trauma registry, and the probability of survival was calculated for all patients. Summary data, including registry information and details of prehospital, emergency room, and definitive care, were provided to all members of the peer review committee 1 week before the committee meeting. The committee then reviewed all cases and classified each death as preventable, potentially preventable, or non-preventable.
A total fo 279 patients were registered in the trauma registry during the study period, including 18 trauma deaths. Peer review judged that six were preventable, seven were potentially preventable, and four were non-preventable. One patient was excluded because the record was not available for review. The proportion of preventable and potentially preventable deaths was significantly higher in our study than from developed countries. Of the multiple contributing factors identified, the most important were inadequate prehospital transfer, limited hospital resources, and an absence of integrated and organized trauma care. This study summarizes the challenges faced in trauma care in a developing country.
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ABSTRACT: Trauma is an increasingly significant health problem globally, especially in low-income and middle-income countries. Trauma care is often compromised by economic restrictions. Many capable individuals are attempting to meet this challenge in their own countries, however. This review summarizes such efforts and assesses how they might be expanded in a comprehensive, global fashion. Options for improving trauma care in the prehospital setting have been explored, including strengthening existing, basic formal emergency medical services (including ambulances); instituting new formal emergency medical services, where none had previously existed; and exploring novel ways to strengthen existing, although informal, systems of prehospital care when formal emergency medical services would be unfeasible. Affordable ways by which to strengthen hospital care have been addressed for several specific injuries, including open fractures, burns, and vascular injuries. Especially notable are growing efforts to better monitor outcomes and address factors contributing to preventable deaths. The Essential Trauma Care Project has defined and promoted core essential trauma care services that every injured person in the world realistically can and should be able to receive. This project is a collaborative effort of the World Health Organization and the International Society of Surgery. Individual efforts must be built upon to make progress in a comprehensive, global fashion. This review summarizes the background, achievements, and future potential of the Essential Trauma Care Project and several related efforts.Current Opinion in Critical Care 01/2006; 11(6):568-75. DOI:10.1097/01.ccx.0000186373.49320.65
Chapter: Gender Differentials in Health[Show abstract] [Hide abstract]
ABSTRACT: In health, more than in other social sectors, sex (biological) and gender (behavioral and social) variables are acknowledged useful parameters for research and action because biological differences between the sexes determine male-specific and female-specific diseases and because behavioral differences between the genders assign a critical role to women in relation to family health. Until recently, however, the importance of sex and gender informed work on female-specific diseases but did not carry over to diseases shared by men and women. As a result, the literature contained comparatively little about which diseases affect men and women differently, why that difference might be the case, and how to structure prevention and treatment in response to these differences. This situation has changed, however, and interest in measuring, understanding, and responding to sex and gender differentials in disease has surged, nurtured by breakthroughs in science and advances in advocacy. In line with this interest and using global burden-of-disease data for 2001, this chapter reviews worldwide gender differentials in mortality and morbidity that result in excess disease burdens for women and examines cost-effective interventions drawn from chapters 17 (on sexually transmitted infections), 26 (on maternal and perinatal conditions), 29 (on health service interventions for cancer control in developing countries), 31 (on mental disorders), 32 (on neurological disorders), 51 (on musculoskeletal disability and rehabilitation), and 57 (on contraception) to address them.Disease Control Priorities in Developing Countries, 2nd edited by Dean T Jamison, Joel G Breman, Anthony R Measham, George Alleyne, Mariam Claeson, David B Evans, Prabhat Jha, Anne Mills, Philip Musgrove, 01/2006: chapter Chapter 10; World Bank., ISBN: 0821361791
Chapter: Mental Disorders[Show abstract] [Hide abstract]
ABSTRACT: This chapter focuses on the attributable and avoidable burden of four leading contributors to mental ill health globally: schizophrenia and related nonaffective psychoses, bipolar affective disorder (manic-depressive illness), major depressive disorder, and panic disorder. The choice of these disorders is determined not only by their contribution to disease burden, but also by the availability of data for the cost-effectiveness analyses. Even where such data are available, they are often from industrial countries and extrapolation has been necessary. The exclusion of other mental disorders, such as childhood disorders, from analysis is not because the authors consider these disorders unimportant but because of the paucity of data. Also, this chapter does not specifically deal with the important issue of suicide. A background paper on suicide in developing countries has been developed as part of the Disease Control Priorities Project (DCPP) and is available (Vijayakumar, Nagaraj, and John 2004). The economic analysis presented in this chapter uses the cost-effectiveness analysis methodology specifically developed for the DCPP. The authors recognize that mental disorders impose costs and burdens on families as well as individuals that are not captured by the DALY. Treatment will alleviate some of this burden in addition to alleviating symptoms and disability. A description of the major clinical features, natural course, epidemiology, burden, and treatment effectiveness for each group of disorders is given in the next section. For diagnostic criteria, readers are referred to The ICD-10 Classification of Mental and Behavioral Disorders (ICD-10) (WHO 1992) or Diagnostic and Statistical Manual of Mental Disorders (DSM-IVTR) (American Psychiatric Association 2000). A discussion follows of population-level costs and cost-effectiveness of interventions capable of reducing the current burden associated with four disorders in different developing regions of the world (tables 31.2–31.6), before moving to a discussion of key issues and implications for mental health policy and improvement of services in developing regions of the world.Disease Control Priorities in Developing Countries, 2nd edited by Dean T Jamison, Joel G Breman, Anthony R Measham, George Alleyne, Mariam Claeson, David B Evans, Prabhat Jha, Anne Mills, Philip Musgrove, 01/2006: chapter Chapter 31; World Bank., ISBN: 0821361791