Potentially preventable prehospital deaths from motor vehicle collisions

ABSTRACT

Background: In 2011, about 30,000 people died in motor vehicle collisions (MVCs) in the United States. We sought to evaluate the causes of prehospital deaths related to MVCs and to assess whether these deaths were potentially preventable.

Methods: Miami–Dade Medical Examiner records for 2011 were reviewed for all prehospital deaths of occupants of 4-wheeled motor vehicle collisions. Injuries were categorized by affected organ and anatomic location of the body. Cases were reviewed by a panel of 2 trauma surgeons to determine cause of death and whether the death was potentially preventable. Time to death and hospital arrival times were determined using the Fatality Analysis Reporting System (FARS) data from 2002 to 2012, which allowed comparison of our local data to national prevalence estimates.

Results: Local data revealed that 39% of the 98 deaths reviewed were potentially preventable (PPD). Significantly more patients with PPD had neurotrauma as a cause of death compared to those with a nonpreventable death (NPD) (44.7% vs. 25.0%, P =.049). NPDs were significantly more likely to have combined neurotrauma and hemorrhage as cause of death compared to PPDs (45.0% vs. 10.5%, P <.001). NPDs were significantly more likely to have injuries to the chest, pelvis, or spine. NPDs also had significantly more injuries to the following organ systems: lung, cardiac, and vascular chest (all P <.05). In the nationally representative FARS data from 2002 to 2012, 30% of deaths occurred on scene and another 32% occurred within 1 h of injury. When comparing the 2011 FARS data for Miami–Dade to the remainder of the United States in that year, percentage of deaths when reported on scene (25 vs. 23%, respectively) and within 1 h of injury (35 vs. 32%, respectively) were similar.

Conclusions: Nationally, FARS data demonstrated that two thirds of all MVC deaths occurred within 1 h of injury. Over a third of prehospital MVC deaths were potentially preventable in our local sample. By examining injury patterns in PPDs, targeted intervention may be initiated.

KEYWORDS:

• car
• road
• traffic
• crash
• accident
• injury
• mortality

Acknowledgment

We thank the staff at the Miami–Dade Medical Examiner Department as well as Olga Quintana and Mary Murtha from Jackson Memorial Hospital for their assistance with the data acquisition. We also thank Katherina Julien for her assistance with data collection and management.

Author contributions

JJR, JSD, RMV, LHB, and CIS participated in the study conception and design; SSS, JSD, HD, and JG participated in the acquisition of data. JJR, JPM, JSD, RMV, and CIS participated in analysis and interpretation of the data. JJR, JPM, SSS, and CIS drafted the article and GB, LHB, and CIS critically revised the article. CIS had overall responsibility for the study, including conception and experimental design; analysis and interpretation of data; drafting and revision of the article and tables; statistical expertise and evaluation; and supervision.