Preventable trauma deaths and health system strengthening recommendations: findings from a multi-disciplinary expert panel review of trauma deaths in the Western Cape, South Africa.

backgroundInjuries rank among the top 5 leading causes of death worldwide with 90% of all injury-related deaths occurring in low- and middle-income countries. Up to 70% of injuries are potentially preventable. One approach to inform strategies to reduce post-injury mortality is expert-led trauma death reviews. The objective of this study is to present the results of an expert review of decedent cases and the associated recommendations for health system improvement.

methodsA cohort of trauma decedents from 2023 was identified from an ongoing study in the Western Cape Province of South Africa. Demographics, injury details, time and location of death, and postmortem findings were collected. In April 2024, a multi-disciplinary expert panel determined preventability for each death and made actionable recommendations for improvements. Analysis of preventable and non-preventable cases was performed using Chi-square, Fisher's exact, and Wilcoxon signed rank tests. A rapid qualitative analysis of recommendations was completed and descriptively summarized.

results210 deaths were reviewed by 30 expert panelists. The largest proportion of deaths were from assaults (39%), followed by gunshot injuries (29%). Overall, 33% of deaths were classified as preventable or potentially preventable. Of the 161 in-hospital and ambulance deaths, 64 (39%) were preventable or potentially preventable. The largest proportion of preventable deaths were from haemorrhage (27, 39%) and multi-organ failure or sepsis (25, 36%). The majority (100, 62.1%) of deaths occurred in an emergency centre. Top recommendations from the panel were: development of protocols for diagnosis and management of severe head injuries, context appropriate and accessible trauma training for all frontline providers particularly junior physicians, improved access to diagnostic CT imaging and operating theatres at non-tertiary facilities, and community initiatives to reduce interpersonal violence.

conclusionOne-third of deaths were preventable or potentially preventable, demonstrating a decrease from a review of 2021 trauma deaths in the same system which found 45% to be preventable. Findings highlight a continued need to increase training and strategic utilization of limited existing resources, such as CT and operating theatres, to improve the quality of trauma care. Preventable trauma death reviews are a powerful methodology to inform actionable change.