Travmatik ölümlerde otopsi raporlarýnýn önlenebilirlik açýsýndan deðerlendirilmesi

AMAÇ: Bu çalýþmada travmatik ölümlerde, travma bakým kalitesinin bir göstergesi olarak önlenebilir ölüm oranlarýnýn ve medikal hatalarýn otopsi raporlarýna göre araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM: Eskiþehir/Türkiye’de 2011 ve 2012 yýllarýna ait travmatik otopsi raporlarý geriye dönük olarak incelendi. Olgularýn demografik verileri, yaralanma tipi, yaralanma nedeni, yaralanma bölgesi, ISS deðerleri, ölüm nedeni ve ölüm yeri kaydedildi. Bütün ölümler önlenebilir, potansiyel önlenebilir ve önlenemez ölümler olmak üzere üç gruba ayrýldý.
BULGULAR: Çalýþma döneminde 386 travmatik otopsi raporu incelendi. Olgularýn %81.9’unun (n=316) künt, %18.1’inin (n=70) ise penetran yaralanmaya maruz kaldýðý gözlendi. Yine olgularýn %56.7’sinin (n=219) olay yerinde, %11.7’sinin hastane öncesinde (n=45), %31.6’sýnýn (n=122) hastanede öldüðü belirlenmiþtir. Önlenebilirlik analizinde olgularýn %4.1’inin önlenebilir (n=16), %14.5’inin (n=56) potansiyel önlenebilir ve %81.3’ünün (n=314) önlenemez nitelikte olduðuna karar verildi. Toplamda olgularýn %65.3’ünde (n=47) suboptimal bakým, %58.3’ünde (n=42) müdahalenin gecikmesi hatalarý gözlendi.
TARTIÞMA: Önlenebilir ölüm oranlarýnýn hastane öncesi periyotta, penetran yaralanmalarda ve özellikle göðüs travmalarýnda yüksek bulunmasýnýn dikkat çekici bulgular olduðu deðerlendirilmektedir.

Evaluation of autopsy reports in terms of preventability of traumatic deaths

BACKGROUND: The analysis of autopsy reports plays an important role in the evaluation of trauma care quality. The objective of this study was to determine the rate of preventable deaths and medical errors in regard to the autopsy reports as an indicator of trauma care quality in traumatic deaths.
METHODS: A retrospective review of traumatic autopsy reports kept between 2011 and 2012 in Eskiþehir, Turkey was conducted. Demographic data of the cases, injury type, injury mechanism, injury location, ISS values, and cause and place of death were recorded. Deaths were judged in three groups including preventable deaths, potentially preventable deaths and non-preventable deaths. In the definiton of preventability, the criteria of American College of Surgeons Committee on Trauma were used. A commission composed of two forensic medicine specialists and one emergency medicine specialist reviewed preventability and defined medical errors.
RESULTS: A total of five hundred and ninety-two autopsy reports were examined in the study period. Trauma was defined as the cause in 65.2% (n=386) of the cases. 81.9% (n=316) of the cases were observed to have suffered blunt injury and 18.1% (n=70) penetrating injury. Death occurred at the scene of trauma in 56.7% (n=219) of the cases, in the pre-hospital period in 11.7% (n=45), and in hospital in 31.6% (n=122). In preventability analysis, it was decided that 4.1% (n=16) of the cases had the properties of being preventable, 14.5% (n=56) potentially preventable and 81.3% (n=314) non-preventable. Suboptimal care was determined in 65.3% (n=47) of the total cases, delayed intervention in 58.3% (n=42), error in the medical method decision in 8.3% (n=6), delayed or wrong diagnosis in 1.4% (n=1), and inappropriate or incorrect medical application in 1.4% (n=1).
CONCLUSION: High rates of preventable deaths in the pre-hospital period, in cases of penetrating injuries, and particularly in cases of chest trauma were evaluated as noteworthy findings. Integrated working of pre-hospital emergency healthcare services with trauma
centres would enable the development of trauma care and reduce the rates of preventable deaths.