An analysis of in-hospital deaths at a modern combat support hospital

Matthew Martin, John Oh, Heather Currier, Nigel Tai, Alec Beekley, Matthew Eckert, John Holcomb

Research output: Contribution to journalArticle

92 Citations (Scopus)

Abstract

BACKGROUND: Analysis of the epidemiology and attribution of in-hospital deaths is a critical component of learning and process improvement for any trauma center. We sought to perform a detailed analysis of in-hospital deaths at a combat support hospital. METHODS: All patients with trauma who survived to admission and subsequently died before transfer or discharge during a 1-year period were included. The timing, location, pathogenesis, and circumstances surrounding the death were recorded. Opportunities for improvement (OI) of care were identified for analysis. Cases were presented to a panel of experts, and preventability of the deaths was scored on a continuous 10-point scale. RESULTS: There were 151 deaths, with the predominant mechanisms of gunshot wounds (GSW) (47%) and blast injuries (42%). Most had severe injuries, with a mean Injury Severity Score of 38, pH of 7.09, and base deficit of 12. Predominant causes of death were head injury (45%) and hemorrhage (32%), and 78% died within 1 hour of admission. Most deaths occurred during the intensive care (35%) or resuscitation phases (31%), but the majority of deaths among nonexpectant patients occurred during the operative phase (38%). OI were identified in 74 deaths (49%), and were found in 78% of nonexpectant deaths. Most improvement opportunities occurred during the resuscitation and transport phases. Most potential improvements were identified at the system level (54%) or individual provider level (42%). Preventability scoring showed excellent inter-rater reliability (r = 0.92, p < 0.001). Deaths with high preventability scores (mean >54) were primarily related to delays in hemorrhage control during the transportation (47%) or resuscitation (43%) phases, and attributed to the system (63%) and individual provider levels (70%). CONCLUSIONS: In-hospital combat trauma-related deaths at a modern Combat support hospital differ significantly from their civilian counterparts, and present multiple OI of care and potential salvage. Delays in prehospital and in-hospital hemorrhage control are the primary contributors to potential preventability.

Original languageEnglish (US)
Pages (from-to)S51-S60
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume66
Issue numberSUPPL. 4
DOIs
StatePublished - Apr 1 2009

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Resuscitation
Wounds and Injuries
Hemorrhage
Blast Injuries
Gunshot Wounds
Injury Severity Score
Trauma Centers
Critical Care
Craniocerebral Trauma
Cause of Death
Epidemiology
Learning

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Martin, Matthew ; Oh, John ; Currier, Heather ; Tai, Nigel ; Beekley, Alec ; Eckert, Matthew ; Holcomb, John. / An analysis of in-hospital deaths at a modern combat support hospital. In: Journal of Trauma - Injury, Infection and Critical Care. 2009 ; Vol. 66, No. SUPPL. 4. pp. S51-S60.
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abstract = "BACKGROUND: Analysis of the epidemiology and attribution of in-hospital deaths is a critical component of learning and process improvement for any trauma center. We sought to perform a detailed analysis of in-hospital deaths at a combat support hospital. METHODS: All patients with trauma who survived to admission and subsequently died before transfer or discharge during a 1-year period were included. The timing, location, pathogenesis, and circumstances surrounding the death were recorded. Opportunities for improvement (OI) of care were identified for analysis. Cases were presented to a panel of experts, and preventability of the deaths was scored on a continuous 10-point scale. RESULTS: There were 151 deaths, with the predominant mechanisms of gunshot wounds (GSW) (47{\%}) and blast injuries (42{\%}). Most had severe injuries, with a mean Injury Severity Score of 38, pH of 7.09, and base deficit of 12. Predominant causes of death were head injury (45{\%}) and hemorrhage (32{\%}), and 78{\%} died within 1 hour of admission. Most deaths occurred during the intensive care (35{\%}) or resuscitation phases (31{\%}), but the majority of deaths among nonexpectant patients occurred during the operative phase (38{\%}). OI were identified in 74 deaths (49{\%}), and were found in 78{\%} of nonexpectant deaths. Most improvement opportunities occurred during the resuscitation and transport phases. Most potential improvements were identified at the system level (54{\%}) or individual provider level (42{\%}). Preventability scoring showed excellent inter-rater reliability (r = 0.92, p < 0.001). Deaths with high preventability scores (mean >54) were primarily related to delays in hemorrhage control during the transportation (47{\%}) or resuscitation (43{\%}) phases, and attributed to the system (63{\%}) and individual provider levels (70{\%}). CONCLUSIONS: In-hospital combat trauma-related deaths at a modern Combat support hospital differ significantly from their civilian counterparts, and present multiple OI of care and potential salvage. Delays in prehospital and in-hospital hemorrhage control are the primary contributors to potential preventability.",
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An analysis of in-hospital deaths at a modern combat support hospital. / Martin, Matthew; Oh, John; Currier, Heather; Tai, Nigel; Beekley, Alec; Eckert, Matthew; Holcomb, John.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 66, No. SUPPL. 4, 01.04.2009, p. S51-S60.

Research output: Contribution to journalArticle

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T1 - An analysis of in-hospital deaths at a modern combat support hospital

AU - Martin, Matthew

AU - Oh, John

AU - Currier, Heather

AU - Tai, Nigel

AU - Beekley, Alec

AU - Eckert, Matthew

AU - Holcomb, John

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N2 - BACKGROUND: Analysis of the epidemiology and attribution of in-hospital deaths is a critical component of learning and process improvement for any trauma center. We sought to perform a detailed analysis of in-hospital deaths at a combat support hospital. METHODS: All patients with trauma who survived to admission and subsequently died before transfer or discharge during a 1-year period were included. The timing, location, pathogenesis, and circumstances surrounding the death were recorded. Opportunities for improvement (OI) of care were identified for analysis. Cases were presented to a panel of experts, and preventability of the deaths was scored on a continuous 10-point scale. RESULTS: There were 151 deaths, with the predominant mechanisms of gunshot wounds (GSW) (47%) and blast injuries (42%). Most had severe injuries, with a mean Injury Severity Score of 38, pH of 7.09, and base deficit of 12. Predominant causes of death were head injury (45%) and hemorrhage (32%), and 78% died within 1 hour of admission. Most deaths occurred during the intensive care (35%) or resuscitation phases (31%), but the majority of deaths among nonexpectant patients occurred during the operative phase (38%). OI were identified in 74 deaths (49%), and were found in 78% of nonexpectant deaths. Most improvement opportunities occurred during the resuscitation and transport phases. Most potential improvements were identified at the system level (54%) or individual provider level (42%). Preventability scoring showed excellent inter-rater reliability (r = 0.92, p < 0.001). Deaths with high preventability scores (mean >54) were primarily related to delays in hemorrhage control during the transportation (47%) or resuscitation (43%) phases, and attributed to the system (63%) and individual provider levels (70%). CONCLUSIONS: In-hospital combat trauma-related deaths at a modern Combat support hospital differ significantly from their civilian counterparts, and present multiple OI of care and potential salvage. Delays in prehospital and in-hospital hemorrhage control are the primary contributors to potential preventability.

AB - BACKGROUND: Analysis of the epidemiology and attribution of in-hospital deaths is a critical component of learning and process improvement for any trauma center. We sought to perform a detailed analysis of in-hospital deaths at a combat support hospital. METHODS: All patients with trauma who survived to admission and subsequently died before transfer or discharge during a 1-year period were included. The timing, location, pathogenesis, and circumstances surrounding the death were recorded. Opportunities for improvement (OI) of care were identified for analysis. Cases were presented to a panel of experts, and preventability of the deaths was scored on a continuous 10-point scale. RESULTS: There were 151 deaths, with the predominant mechanisms of gunshot wounds (GSW) (47%) and blast injuries (42%). Most had severe injuries, with a mean Injury Severity Score of 38, pH of 7.09, and base deficit of 12. Predominant causes of death were head injury (45%) and hemorrhage (32%), and 78% died within 1 hour of admission. Most deaths occurred during the intensive care (35%) or resuscitation phases (31%), but the majority of deaths among nonexpectant patients occurred during the operative phase (38%). OI were identified in 74 deaths (49%), and were found in 78% of nonexpectant deaths. Most improvement opportunities occurred during the resuscitation and transport phases. Most potential improvements were identified at the system level (54%) or individual provider level (42%). Preventability scoring showed excellent inter-rater reliability (r = 0.92, p < 0.001). Deaths with high preventability scores (mean >54) were primarily related to delays in hemorrhage control during the transportation (47%) or resuscitation (43%) phases, and attributed to the system (63%) and individual provider levels (70%). CONCLUSIONS: In-hospital combat trauma-related deaths at a modern Combat support hospital differ significantly from their civilian counterparts, and present multiple OI of care and potential salvage. Delays in prehospital and in-hospital hemorrhage control are the primary contributors to potential preventability.

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