Preventable Trauma Deaths Epidemiology, Causes of Death, and Management Failures

Fatal trauma is one of the leading causes of death in Western industrialized countries. The aim of the present study was to determine the preventability of traumatic deaths, analyze the medical measures related to preventable deaths, detect management failures, and reveal specific injury patterns. All autopsied, direct trauma-related fatalities in Berlin in 2010 were included with systematic data acquisition, including police files, medical records, death certificates, and autopsy records. An interdisciplinary expert board judged the preventability of traumatic death according to the classification of non-preventable (NV), potentially preventable (PV), and definitively preventable (DV) fatalities. 85% were classified as NV, 10% as PV, and 5% as DV. The incidence of severe traumatic brain injury was significantly lower in PV/DV than in NV, and the incidence of fatal exsanguinations was significantly higher. Most PV and NV deaths occurred in the pre-hospital setting. Notably, no PV or DV was recorded for fatalities treated by airbound rescue service. Causes of DV deaths consisted of tension pneumothorax, unrecognized trauma, exsanguinations, and asphyxia. The overall trauma mortality in our study, compared to worldwide-published data, is low. Nevertheless, 15% of traumatic deaths were classified as preventable. Compulsory training in trauma management might further reduce trauma-related mortality. The main focus should remain on prevention programs, as the majority of the fatalities occurred as a result of non-survivable injuries.