Article

Peer review audit of trauma deaths in a developing country

Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
Asian Journal of Surgery (Impact Factor: 0.76). 02/2004; 27(1):58-64. DOI: 10.1016/S1015-9584(09)60247-5
Source: PubMed

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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    • "The undue delay in the referred group was due to the multiple referrals and unnecessary distances traveled due to lack of triage and transfer protocols. This chaos in prehospital care is expected as no national or regional guidelines exist for triage, patient-delivery decisions, prehospital treatment plans, and inter hospital transfer protocol in India[1] and other developing countries like Pakistan.[34] Unfortunately, development of prehospital and institutional trauma care does not always grow in a coordinated manner.[8] "
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