地方病院における防ぎ得た外傷死（Preventable Trauma Death）の検討

• Published in: Journal of the Japanese Association for the Surgery of Trauma Vol. 30; no. 3; pp. 304 - 311
• Main Authors: 吉村 有矢, 今 明秀, 野田頭 達也
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本外傷学会 2016; The Japanese Association for the Surgery of Trauma
• Subjects: Japan Trauma Data Bank; peer review; quality of trauma care; 外傷診療の質; 日本外傷データバンク; 第三者評価
• ISSN: 1340-6264; 2188-0190
• DOI: 10.11382/jjast.30.304

Background : One of the major aims of improvements in trauma care is to reduce preventable trauma deaths, but few studies about this topic have been conducted in Japan. Objective : The objective of this study was to analyze the preventable trauma deaths that occurred at a rural hospital in Japan. Methods : This was a single-center study examining 147 trauma deaths that occurred between 2010 and 2014 at our hospital in Hachinohe (a rural city), Japan. Unexpected deaths, which were identified using the trauma and injury severity score (TRISS), were analyzed within 30 days via a mortality peer review. The review panels were comprised of trauma surgeons from other institutions and doctors from our department. Results : Seventeen (11%) deaths were identified as unexpected based on their TRISS, and 5 (3.4%) deaths were judged to have been preventable during the peer reviews. The overall preventable death rate was 3.4%. The preventable deaths were caused by delays in treatment and prehospital undertriage. The TRISS system was found to have a number of limitations related to injury severity, age, premorbid conditions, and complications. Conclusions : This study has identified errors that contributed to preventable trauma deaths at a rural hospital in Japan. The TRISS method has many limitations. Peer review is a more effective tool for evaluating and improving the quality of trauma care. 　【目的】地方病院におけるPreventable Trauma Death（以下PTD）の検討，外傷診療の質の評価と向上【対象と方法】当院の2010〜2014年度における日本外傷データバンク登録症例を対象とし，Trauma and Injury Severity Score（TRISS）法と第三者を加えたpeer reviewによりPTDを判定した．【結果】死亡例は147例．受傷30日以内に死亡した予測外死亡は17例．peer reviewで５例をPTDと判定した．その原因は救急室の初期治療の遅れ４例，搬送先選定の誤り１例．一方，予測外死亡が死亡回避不可とされた理由は，既往症４例，重症頭部外傷３例，高齢２例，死因不明２例，合併症１例であった．【考察】本邦におけるPTDの報告は少ない．TRISS法のみのPTD判定には限界がある．第三者を加えたpeer reviewを追加することで，外傷診療の質の評価と問題点の抽出が可能となり，改善に取り組んだ．【結語】客観的なpeer reviewによるPTDの検討が必要である．