Data from: Preventable trauma deaths in the Western Cape of South Africa: A consensus-based panel review
Data files
Nov 04, 2024 version files 55.45 KB
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PLOSGPH_Prevenatable_Death_De-identified_Dataset_3Nov2024.xlsx
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README.md
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Abstract
Injury causes 4.4 million deaths worldwide annually. 90% of all injury-related deaths occur in low-and-middle-income countries. Findings from expert-led trauma death reviews can inform strategies to reduce trauma deaths. A cohort of trauma decedents was identified from an ongoing study in the Western Cape Province of South Africa. For each case, demographics, injury characteristics, time and location of death, and postmortem findings were collected. An expert multidisciplinary panel of reviewed each case, determined preventability, and made recommendations for improvement. 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 conducted and descriptively summarized. 138 deaths (48 deceased-on-scene and 90 pre- or in-hospital deaths) were presented to 23 panelists. Overall, 46 (33%) of deaths reviewed were considered preventable or potentially preventable. Of all pre- and in-hospital deaths, late deaths (>24 hours) were more frequently preventable (22, 56%) and due to multi-organ failure and sepsis, compared to early deaths (≤24 hours) with 32 (63%) that were non-preventable and due to central nervous system injury and haemorrhage. 45% of pre and in-hospital deaths were preventable or potentially preventable. The expert panel recommended strengthening community-based primary prevention strategies for reducing interpersonal violence alongside health system improvements to facilitate high-quality care. For the health system, the panel’s key recommendations included improving team-based care, adherence to trauma protocols, timely access to radiology, trauma specialists, and operative and critical care.
https://doi.org/10.5061/dryad.h70rxwdrm
Description of the data and file structure
Each row of data represents a unique patient who died from a traumatic injury in the Western Cape, South Africa in 2021. Columns include relevant clinical, and outcome variables, columns also include codes assigned to recommendations for improvement in the health system based on expert panel discussions. A key on the second sheet includes further descriptions of each variable. Keys for the qualitative codes are included as supplemental material with the original manuscript.10.1371/journal.pgph.0003122
Sharing/Access information
Data was derived from the following sources:
• Abstraction from patient clinical records
• Codes assigned to detailed notes during the case review panel
Variable Description Variable Type Options for Categorical Variables
“Record ID Field” Unique study ID Numeric N/A
age_cat Category of Age Categorical
18-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
d_injmech Mechanism of Injury Categorical “Firearm
Struck/hit
Stabbing or cut
Vehicular Injury
Fall
Other”
d_injfrc Injury Force Type Categorical “Blunt
Penetrating
Burn
Other
Blunt + Penetrating”
f_cod Cause of Death Categorical “Single blunt force injury
Multiple blunt force injury
Single penetrating injury
Multiple penetrating injury
Blast
Thermal
Other”
d_ais_1bd AIS body region 1 Categorical “0 Other trauma
1 Head
2 Face
3 Neck
4 Thorax
5 Abdomen
6 Spine
7 Upper extremity
8 Lower extremity
9 External”
d_ais_1svr AIS severity 1 Categorical “AIS 1 - Minor
AIS 2 - Moderate
AIS 3 - Serious
AIS 4 - Severe
AIS 5 - Critical
AIS 6 - Maximal
AIS 9 - Unknown”
d_ais_2bd AIS body region 2 Categorical “0 Other trauma
1 Head
2 Face
3 Neck
4 Thorax
5 Abdomen
6 Spine
7 Upper extremity
8 Lower extremity
9 External”
d_ais_2svr AIS severity 2 Categorical “AIS 1 - Minor
AIS 2 - Moderate
AIS 3 - Serious
AIS 4 - Severe
AIS 5 - Critical
AIS 6 - Maximal
AIS 9 - Unknown”
d_ais_3bd AIS body region 3 Categorical “0 Other trauma
1 Head
2 Face
3 Neck
4 Thorax
5 Abdomen
6 Spine
7 Upper extremity
8 Lower extremity
9 External”
d_ais_3svr AIS severity 3 Categorical “AIS 1 - Minor
AIS 2 - Moderate
AIS 3 - Serious
AIS 4 - Severe
AIS 5 - Critical
AIS 6 - Maximal
AIS 9 - Unknown”
d_ais_4bd AIS body region 4 Categorical “0 Other trauma
1 Head
2 Face
3 Neck
4 Thorax
5 Abdomen
6 Spine
7 Upper extremity
8 Lower extremity
9 External”
d_ais_4svr AIS severity 4 Categorical “AIS 1 - Minor
AIS 2 - Moderate
AIS 3 - Serious
AIS 4 - Severe
AIS 5 - Critical
AIS 6 - Maximal
AIS 9 - Unknown”
d_ais_5bd AIS body region 5 Categorical “0 Other trauma
1 Head
2 Face
3 Neck
4 Thorax
5 Abdomen
6 Spine
7 Upper extremity
8 Lower extremity
9 External”
d_ais_5svr AIS severity 5 Categorical “AIS 1 - Minor
AIS 2 - Moderate
AIS 3 - Serious
AIS 4 - Severe
AIS 5 - Critical
AIS 6 - Maximal
AIS 9 - Unknown”
d_ais_6bd AIS body region 6 Categorical “0 Other trauma
1 Head
2 Face
3 Neck
4 Thorax
5 Abdomen
6 Spine
7 Upper extremity
8 Lower extremity
9 External”
d_ais_6svr AIS severity 6 Categorical “AIS 1 - Minor
AIS 2 - Moderate
AIS 3 - Serious
AIS 4 - Severe
AIS 5 - Critical
AIS 6 - Maximal
AIS 9 - Unknown”
d_ais_7bd AIS body region 7 Categorical “0 Other trauma
1 Head
2 Face
3 Neck
4 Thorax
5 Abdomen
6 Spine
7 Upper extremity
8 Lower extremity
9 External”
d_ais_7svr AIS severity 7 Categorical “AIS 1 - Minor
AIS 2 - Moderate
AIS 3 - Serious
AIS 4 - Severe
AIS 5 - Critical
AIS 6 - Maximal
AIS 9 - Unknown”
d_ais_8bd AIS body region 8 Categorical “0 Other trauma
1 Head
2 Face
3 Neck
4 Thorax
5 Abdomen
6 Spine
7 Upper extremity
8 Lower extremity
9 External”
d_ais_8svr AIS severity 8 Categorical “AIS 1 - Minor
AIS 2 - Moderate
AIS 3 - Serious
AIS 4 - Severe
AIS 5 - Critical
AIS 6 - Maximal
AIS 9 - Unknown”
d_ais_9bd AIS body region 9 Categorical “0 Other trauma
1 Head
2 Face
3 Neck
4 Thorax
5 Abdomen
6 Spine
7 Upper extremity
8 Lower extremity
9 External”
d_ais_9svr AIS severity 9 Categorical “AIS 1 - Minor
AIS 2 - Moderate
AIS 3 - Serious
AIS 4 - Severe
AIS 5 - Critical
AIS 6 - Maximal
AIS 9 - Unknown”
d_ais_10bd AIS body region 10 Categorical “0 Other trauma
1 Head
2 Face
3 Neck
4 Thorax
5 Abdomen
6 Spine
7 Upper extremity
8 Lower extremity
9 External”
d_ais_10svr AIS severity 10 Categorical “AIS 1 - Minor
AIS 2 - Moderate
AIS 3 - Serious
AIS 4 - Severe
AIS 5 - Critical
AIS 6 - Maximal
AIS 9 - Unknown”
d_NISS New Injury Severity Score Numeric N/A
a5_admit_death_hr Time from admission to death (hours) Numeric N/A
mod Mechanism of Death Categorical “Catastrophic tissue destruction
CNS (central nervous system) injury
Hemorrhage or exsanguination
Multiple organ failure + Sepsis
Comorbities
Other”
Preventability Preventability designation Categorical “Preventable
Potentially Preventable
Non-preventable (with improvements)
Non-preventable
Indeterminate”
Category_Def_1 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-3”
Category_Def_2 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-4”
Category_Def_3 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-5”
Category_Def_4 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-6”
Category_Def_5 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-7”
Category_Def_6 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-8”
Category_Def_7 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-9”
Category_Def_8 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-10”
Category_Def_9 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-11”
Category_Def_10 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-12”
Category_Def_11 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-13”
Category_Def_12 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-14”
Category_Def_13 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-15”
Category_Def_14 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-16”
Category_Def_15 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-17”
Category_Def_16 Category of Preventability Categorical* see below “FO-PGP-1
FO-PGP-2
FO-R-1
FO-R-2
FO-R-3
FO-R-6
HS-CD-1
HS-CD-2
HS-CD-3
HS-PGP-3
HS-PGP-5
HS-R-1
HS-R-2
HS-R-3
HS-R-4
HS-R-5
PC-CF-5
PC-E-3
PC-E-4
PC-P-2
PP-CC-1
PP-CC-3
PP-CC-4
PP-CC-5
PP-CD-1
PP-CD-2
S-P-1
U-CC-1
U-CD-1
U-PGP-1
U-PGP-4
U-R-1
U-R-18”
tod Time of death from injury designation Categorical “<6
>24”
todfa Time of death from hospital arrival Categorical “<=6
6-12
12-24
24-48
48+”
d_dstc1 Region of death Categorical “Urban
Rural”
uoc Unit of Care where death occurred collapsed Categorical “EMS
Ward/ICU/OT
EC1
EC2”
todfi Time of death from injury Categorical “<=6
6-12
12-24
24-28
48+”
Category_Def Columns P-AE
Level of Deficiency (within health system): Communication & Documentation Clinical Care Resources Policy, Guidelines, or Protocols
Health System HS-CD-1: Communication between EMS and facilities. HS-R-1: Care impacted by lack of access to radiology (CT scanners; radiographers; radiologists). HS-PGP-1: Lack of central trauma bed management protocols.
HS-CD-2: Standard referral processes/channels to facilitate communication.
HS-R-2: Care impacted by lack of access to theatre.
HS-PGP-2: Absent or poor inter-facility trauma referral pathways
HS-CD-3: Documentation of injury incident time.
HS-R-3: Care impacted by lack of access to critical care beds
HS-PGP-3: Absent or unused EMS trauma referral protocols
HS-R-4: Care impacted by lack of access to trauma care beds.
HS-PGP-4: Absent system-wide Crush protocol.
HS-R-5: Limited EMS availability (ALS, IFTs, rural etc).
HS-PGP-5: Protocols for penetrating head injuries.
HS-R-6: Need for hemodialysis units/resources.
Facility FO-R-1: Access to OT at the district level.
Organization FO-R-2: Access to OT at the tertiary level. FO-PGP-1: EMS ALS dispatch criteria.
FO-R-3: Access to radiology at district level.
FO-PGP-2: EMS ‘load and go’ policies.
FO-R-4: Access to radiology at tertiary level.
FO-R-5: Lack of critical care beds at select district level.
FO-R-6: Access to critical care beds at tertiary level.
Unit(s) U-CD-1: Handover U-CC-1: Lack of clinical providers/no ownership of admitted patients. U-R-1: Access to timely specialty care. U-PGP-1: Absent palliative care/de-escalation of care protocols.
U-CC-2: Culture of poor adherence to clinical protocols.
U-R-2: Access to critical care beds.
U-PGP-2: Poor team-based trauma care.
U-R-3: Access to patient monitoring.
U-PGP-3: No Crush treatment protocols.
U-R-4: Access to medications/blood products.
U-PGP-4: No massive blood transfusion guidelines or protocols.
U-PGP-5: No hypothermia management protocols.
U-PGP-6: SOPs for nursing monitoring and documentation
People (providers) PP-CD-1: Missing/poor provider documentation. PP-CC-1: Missed or delay in diagnosis (not Crush) PP-R-1: Inadequate number of burn specialists. PP-PGP-1: Lack of awareness or adherence to guidelines.
PP-CD-2: Inattention to vital signs.
PP-CC-2: Missed or delay in diagnosis (Crush Syndrome)
PP-R-2: Inadequate number of spinal cord injury specialists.
PP-CC-3: General quality of care concern e.g., re-warming, anchoring biases, poor ATLS. PP-R-3: Inadequate number of intensivists.
PP-CC-4: Prolonged EMS scene times.
PP-R-4: Inadequate number of surgery inpatient providers.
PP-CC-5: Gaps in early resuscitation:
PP-R-5: Inadequate nursing (high ratios, low numbers in units, etc)
· Basic resuscitation
· Antibiotics
Deficiency level (outside the health system): Communication & Documentation Education Community Factors Policies
System (transport, police, legal, etc) S-CD-1: Missing or poor police/scene documentation. S-CF-1: Community assault as method of self-policing. S-P-1: Gun legislation/gun control.
S-P-2: Road Safety, primary prevention (PVA).
S-P-3: Inadequate ‘Red Zone’ policing/security.
People PC-E-1: Alcohol abuse. PC-CF-1: Socioeconomics of interpersonal violence. PC-P-1: Alcohol abuse in community.
(community) PC-E-2: Interpersonal violence. PC-CF-2: Gender based violence. PC-P-2: Interpersonal violence (IPV):
PC-E-3: Road Safety (esp. PVA).
PC-CF-3: Domestic violence. · Firearms
PC-E-4: Gun Safety.
PC-CF-4: Barriers to accessing care. · Knife/stabs
PC-E-5: Decision to seek care.
PC-CF-5: Lack of community mental health resources. · Community Assault
PC-E-6: Decisions to call EMS.
PC-P-3: Poor pedestrian road safety culture/poor awareness on PVAs.