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Comparison of Military and Civilian Methods for Determining Potentially Preventable Deaths: A Systematic Review.

Abstract：

Importance:Military and civilian trauma experts initiated a collaborative effort to develop an integrated learning trauma system to reduce preventable morbidity and mortality. Because the Department of Defense does not currently have recommended guidelines and standard operating procedures to perform military preventable death reviews in a consistent manner, these performance improvement processes must be developed. Objectives:To compare military and civilian preventable death determination methods to understand the existing best practices for evaluating preventable death. Evidence Review:This systematic review followed the PRISMA reporting guidelines. English-language articles were searched from inception to February 15, 2017, using the following databases: MEDLINE (Ovid), Evidence-Based Medicine Reviews (Ovid), PubMed, CINAHL, and Google Scholar. Articles were initially screened for eligibility and excluded based on predetermined criteria. Articles reviewing only prehospital deaths, only inhospital deaths, or both were eligible for inclusion. Information on study characteristics was independently abstracted by 2 investigators. Reported are methodological factors affecting the reliability of preventable death studies and the preventable death rate, defined as the number of potentially preventable deaths divided by the total number of deaths within a specific patient population. Findings:Fifty studies (8 military and 42 civilian) met the inclusion criteria. In total, 1598 of 6500 military deaths reviewed and 3346 of 19 108 civilian deaths reviewed were classified as potentially preventable. Among military studies, the preventable death rate ranged from 3.1% to 51.4%. Among civilian studies, the preventable death rate ranged from 2.5% to 85.3%. The high level of methodological heterogeneity regarding factors, such as preventable death definitions, review process, and determination criteria, hinders a meaningful quantitative comparison of preventable death rates. Conclusions and Relevance:The reliability of military and civilian preventable death studies is hindered by inconsistent definitions, incompatible criteria, and the overall heterogeneity in study methods. The complexity, inconsistency, and unpredictability of combat require unique considerations to perform a methodologically sound combat-related preventable death review. As the Department of Defense begins the process of developing recommended guidelines and standard operating procedures for performing military preventable death reviews, consideration must be given to the factors known to increase the risk of bias and poor reliability.

journal_name

JAMA Surg

journal_title

JAMA surgery

authors

Janak JC,Sosnov JA,Bares JM,Stockinger ZT,Montgomery HR,Kotwal RS,Butler FK,Shackelford SA,Gurney JM,Spott MA,Finelli LN,Mazuchowski EL,Smith DJ

doi

10.1001/jamasurg.2017.6105

subject

Has Abstract

pub_date

2018-04-01 00:00:00

pages

367-375

issue

eissn

2168-6254

issn

2168-6262

pii

2673190

journal_volume

153

pub_type

杂志文章

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Comparison of Military and Civilian Methods for Determining Potentially Preventable Deaths: A Systematic Review.