DOI: 10.5061/dryad.h70rxwdrm
title: Data from: Preventable trauma deaths in the Western Cape of South Africa: A consensus-based panel review

description: 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 (&gt;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.
description: # Preventable trauma deaths in the Western Cape of South Africa: A
 consensus-based panel review.
 [https://doi.org/10.5061/dryad.h70rxwdrm](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 "&lt;6 \&gt;24" todfa Time of death from hospital arrival Categorical "&lt;=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 "&lt;=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. ```