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Abstract
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INTRODUCTION: The study of preventable deaths is essential to trauma research for measuring service quality, highlighting avenues for improving care and as a performance indicator. However variations in the terminology and methodology of studies on preventable prehospital trauma death limit the comparability and wider application of data. The objective of this study was to describe the heterogeneity in terminology and methodology.
METHODS: We performed a systematic literature review and report this using the PRISMA guidelines. Searches were conducted using PubMed (including Medline), Ovid and Embase databases. Studies, with a full text available in English published between 1990 and 2015, meeting the following inclusion criteria were included: analysis of 1) deaths from trauma 2) occurring in the prehospital phase of care 3) application of criteria to ascertain whether deaths were preventable. One author screened database results for relevance by title and abstract. The full text of identified papers was reviewed for inclusion. The reference list of included papers was screened for studies not identified by the database search. Data was extracted on pre-defined core elements relating to preventability reporting and definitions using a standardized form.
RESULTS: Twenty-seven studies meeting the inclusion criteria were identified: 12 studies used two categories to assess the preventability of death while 15 used three categories. Fifteen variations in the terminology of these categories and combination with death descriptors were found. Eleven different approaches were used in defining what constituted a preventable death. Twenty-one included survivability of injuries as a criterion.
METHODS used to determine survivability differed and eight variations in parameters for categorization of deaths were used. Nineteen used panel review in determining preventability with six implementing panel blinding. Panel composition varied greatly by expertise of personnel. Separation of prehospital deaths differed with ten separating those Dead at Scene (DAS) and Dead on Arrival (DOA), three excluding those DAS, three excluding deaths prior to EMS arrival and eleven not separating prehospital deaths.
CONCLUSION: The heterogeneity in methodology, terminology and definitions of "preventable" between studies render data incomparable. To facilitate common understanding, comparability and analysis, a commonly agreed ontology by the prehospital research community is required. This article is protected by copyright. All rights reserved.
Language: en |