Preventable Trauma Deaths and Corrective Actions to Prevent Them: A 10-Year Comparative Study at the Komfo Anokye Teachi
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SURGERY IN LOW AND MIDDLE INCOME COUNTRIES
Preventable Trauma Deaths and Corrective Actions to Prevent Them: A 10-Year Comparative Study at the Komfo Anokye Teaching Hospital, Kumasi, Ghana Dominic Konadu-Yeboah1 • Kusi Kwasi1 • Peter Donkor2 • Senyo Gudugbe1 • Ossei Sampen3 • Augustus Okleme2 • Frank Nketiah Boakye2 • Maxwell Osei-Ampofo4 Helena Okrah5 • Charles Mock6
•
Accepted: 1 July 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Objective To determine the rate of preventable trauma deaths in an African hospital, identify the potential effect of improvements in trauma care over the past decade and identify deficiencies in care that still need to be addressed. Methods A multidisciplinary panel assessed pre-hospital, hospital, and postmortem data on 89 consecutive inhospital trauma deaths over 5 months in 2017 at the Komfo Anokye Teaching Hospital. The panel judged the preventability of each death. For definitely and potentially preventable deaths, the panel identified deficiencies in care. Results Thirteen percent (13%) of trauma deaths were definitely preventable, 47% potentially preventable, and 39% non-preventable. In comparison with a panel review in 2007, there was no change in total preventable deaths, but there had been a modest decrease in definitely preventable deaths (25% in 2007 to 13% in 2017, p = 0.07) There was a notable change in the pattern of deficiency (p = 0.001) with decreases in pre-hospital delay (19% of all trauma deaths in 2007 to 3% in 2017) and inadequate resuscitation (17 to 8%), but an increase in delay in treatment at the hospital (23 to 40%). Conclusions Over the past decade, there have been improvements in pre-hospital transport and in-hospital resuscitation. However, the preventable death rate remains unacceptably high and there are still deficiencies to address. This study also demonstrates that preventable death panel reviews are a feasible method of trauma quality improvement in the low- and middle-income country setting.
& Charles Mock [email protected] 1
Directorate of Trauma and Orthopaedics, Komfo Anokye Teaching Hospital, Kumasi, Ghana
2
Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
3
Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
4
Directorate of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
5
Department of Anaesthesia, Komfo Anokye Teaching Hospital, Kumasi, Ghana
6
Department of Surgery, University of Washington, Harborview Medical Center, 325 Ninth Avenue, Box 359960, Seattle, WA 98104, USA
123
World J Surg
Introduction Injury is a leading cause of death globally, with rates higher in low- and middle-income countries (LMICs, 69 deaths/100,000/year) than in high-income countries (49 deaths/100,000/year) [1]. Improvements in trauma care can lower this burden. Although some components of trauma care are expensive, many components are not. Improvements in the organization and planning for trauma care can be especially low-cost, yet very effective [2]. In many high-income countries
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