'Avoidable' deaths in two areas of Sweden - Analysis of deaths in hospital after injury

Abstract

Objective: To describe causes of death and other characteristics of 'avoidable' deaths in patients admitted to hospital after trauma, and estimate and analyse changes in the avoidable death rate during the years studied. Design: Retrospective analysis of medico legal autopsy material. Setting: One northern and one western area in Sweden 1988-1996. Subjects: 335 cases who died in hospital after trauma. Main outcome measures: Avoidable death, defined as an Injury Severity Score (ISS) of 35 or less and Abbreviated Injury Scale (AIS)(head) of 4 or less and cause of death. Results: We found 70 avoidable deaths (21%). Among these, 15 (21%) died of head injuries, 17 (24%) of thoracic, abdominal, or pelvic injuries, and 38 (54%) of medical complications. The number of deaths after trauma decreased considerably from 1988-90 to 1994-96, but the proportion who died in hospital remained almost constant. The proportion of avoidable deaths decreased from 22% to 17%, mainly because the proportion of deaths from medical complications was halved. Conclusion: The standard of Swedish in-hospital trauma care has improved, particularly with a reduction in post-traumatic complications. However, there is still room for improvement in the treatment of complications among elderly people.