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Background: Due to widespread demographic changes, populations in industrial countries are ageing. A common tool for quality improvement of trauma care is the analysis of deaths in trauma patients. This study focuses on preventable or potentially preventable deaths, and on patterns of errors in severely injured elderly patients, a group that is under-represented in the literature., Methods: Data from a level 1 trauma center in Germany were analyzed for this study. A retrospective chart analysis was performed for all deceased patients older than 75 years with an Injury Severity Score greater than 15. Additionally, the data from the Trauma Registry of the German Society for Trauma Surgery were used. According to a Trauma Division Morbidity and Mortality conference, and after a review of all authors, deaths were classified as preventable, potentially preventable, and non-preventable., Results: Of the 2,304 patients admitted to the trauma room, 108 met the inclusion criteria. A total of 62 (57.41 %) patients died. Two deaths were declared as preventable deaths (3.23 %) and eight as potentially preventable (12.90 %). The most common preclinical error was associated with airway management. Hemorrhage control was the leading error in the clinical setting. Excessive fluid volume resuscitation was the second most common error detected., Conclusion: The rate of preventable or potentially preventable deaths in severely injured elderly patients is similar to that reported for other age groups. Thus, most errors were human judgment errors or human treatment errors; therefore, education and training in the treatment of severely injured patients is extremely important.

Background: Demographic change is expected to result in an increase in cases of severely injured elderly patients. To determine special considerations in treatment and outcome, patients aged 75 years and older were studied., Methods: All patients in the included age group with an Injury Severity Score (ISS) ≥ 16 upon primary admission to hospital between July 2002 and December 2011 were included in this mortality analysis. The data used for this study was gained partly from data submitted to the German Trauma Register and partly from patients' hospital records. A comparison between survivors and decedents was performed, as well as age-adjusted and ISS-adjusted analyses. The odds ratio and relative risk were used to determine predictors for mortality., Results: One-hundred eight patients met the inclusion criteria. The overall mortality proportion was 57.4%. The decedents were more severely injured (ISS 26 vs. 20, p < 0.001) and suffered more severe head traumas (GCS 4 vs. 12, p < 0.001; AIS head 5 vs. 4, p = 0.006). No differences were found in vital parameters measured at the accident scene or trauma room. Decedents had deranged coagulation with a prolonged PTT (41.1 sec vs. 27.6 sec, p = 0.008) and reduced prothrombin ratio (66.5% vs. 82.8%, p = 0.016)., Conclusions: The treatment of severely injured elderly patients is challenging. The most common cause of accident is falling from less than 3 m with head injuries being determinant. We identified deranged coagulopathy as an important predictor for mortality, suggesting rapid normalization of coagulation might be a key to reducing mortality.

Background: Trauma in pediatric patients is a major cause of death. This study investigated differences between decedents and survivors. Furthermore, an analysis of preventable and potential preventable trauma deaths was conducted and errors in the acute trauma care were investigated., Methods: All patients aged less than 16 years with an Injury Severity Score (ISS) ≥ 16 upon primary admission to the hospital between July 2002 and December 2011 were included in this study. Decedents were compared with survivors and an analysis of deceased children for preventable and potential preventable deaths was conducted. The acute trauma care was investigated regarding errors in treatment., Results: Significant differences were found in Glasgow Coma Scale, Injury Severity Score, Revised Trauma Score, New ISS, Revised Injury Severity Classification, and Trauma and Injury Severity Score. Decedents had a worse head trauma with associated coagulopathy. The overall mortality rate was 13.4%. The majority of death occurred soon after arrival. No long term intensive care unit stay was found.No preventable but one potential preventable death was analyzed. Most errors occurred in fluid volume management and in a delay of starting the therapy for hemorrhage and coagulopathy.Prolonged preclinical rescue time and surgery time within the first 24 hours was found., Conclusions: Head trauma is the determinant factor for mortality in severely injured pediatric patients. Death occurred shortly after arrival and long term intensive care stays might be an exception. In treatment of severely injured children volume management, hemorrhage and coagulopathy management, rescue time, and total surgery time should receive more attention.

Objective: The German society of trauma surgery published the "Treatment of Patients with Severe and Multiple injuries" guideline in 2011. This achieved the highest level of recommendation for guidelines published in Germany. This study investigated if there was an improvement in the survival rates of severed injured patients following the introduction of the guideline in clinical treatment., Methods: All patients with an injury severity score ≥16 on primary admission to hospital between January 2010 and December 2012 (a total of 373 patients) were included in this study. The data for these patients were collected from the German Trauma Registry and from patients' hospital records. Patients who were treated in 2010 were compared with patients who were treated in 2011 and 2012, following the introduction of the "treatment of patients with severe and multiple injuries" guideline in the authors' clinic at the beginning of 2011., Results: Significant differences were found in ISS, RTS, New ISS, and TRISS between 2010 and 2011/2012. No differences were found in the severity of injury when classified by different body regions. Major differences were found in the total volume replacement, the length of emergency surgery, the length of surgery performed within the first 24h and the rate of whole-body computed tomography. The mortality rate dropped from 32.48% in 2010 to 18.75% in 2011/2012 (p=0.003)., Conclusions: The introduction and use of a guideline-based medical care regime for severely injured patients might reduce the rate of mortality., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Introduction: Previous studies reported divergent results concerning the effect of gender on patient outcome after severe injury. Results suggest that women have better outcomes because they have lower rates of sepsis and multi-organ failure. The objective of this analysis was to study gender differences in a Level 1 trauma center in Germany., Methods: Patients who were admitted to hospital between 2002 and 2011 with an Injury Severity Score (ISS) ≥16 were included. Data were collected from the Trauma Registry of the German Society for Trauma Surgery and from hospital records. The effects of gender on a variety of parameters were investigated. To eliminate the influence of differences in ISS, an analysis of groups with similar ISS was performed. Also, a matched-pair analysis of 422 patients was performed., Results: A total of 962 patients met the inclusion criteria. The mortality rate was lower in male patients (25.4% versus 36.59%). Female patients had more severe head injuries, received less fluid volume and had a lower rate of sepsis. Men were more frequently involved in motorcycle accidents and sustained more penetrating trauma. Women were more frequently involved in pedestrian accidents and sustained more falls from under 3 m. The effects of gender were reduced when the data were analyzed by matching ISS. The mortality rate was significantly different in the ISS 26 to 35 group but in mostly all groups, the mortality rate was higher in women. In the matched-pair analysis, the rate of sepsis and the length of the ICU stay were significantly lower in women and the mortality rate showed no significant difference (28.1% for male patients versus 33.01% for female patients). Women died after an average of 5.22 days, and men died after an average of 9.02 days., Conclusions: Gender-based differences in patient outcome after severe trauma were observed in this study. Women are more likely to die in the first days after trauma. Upon extended hospital stay, women had a better survival rate because they had a lower rate of sepsis. No significant differences in mortality rate could be found, but there was a trend towards a higher rate in female patients.