Opportunities for health system strengthening to reduce preventable trauma deaths in the Western Cape Province, South Africa: Findings from an expert panel review

BACKGROUND: Injuries are a leading cause of death and disability worldwide, and disproportionately affect young persons (aged 15 - 49 years) residing in low- and middle-income countries. Panel reviews of trauma deaths are an effective way to identify areas for improvement within a health system. OBJECTIVES: To assess the preventability of trauma deaths that had contact with the health system, and the associated panellists' recommendations for improvements. METHODS: A comprehensive review of injury-related deaths identified by an epidemiological study was conducted in the Western Cape Province of South Africa in April 2022. Panellists identified contributing factors and opportunities for improvement for each case. Investigators assigned a thematic code to each opportunity for improvement, and codes were categorised and mapped into a matrix organised according to the applicable level of the health system and the descriptive category for improvement. RESULTS: Twenty-three multidisciplinary expert panellists reviewed 90 injury deaths that occurred in 2021. The largest proportion of deaths was from firearms (30%), and 41 (45%) of the 90 cases were found to be preventable or potentially preventable. The median time from injury to death was 41.4 hours for rural injuries, compared with 12.9 hours for urban injuries. CONCLUSION: Key recommendations from the panel included training in basic trauma resuscitation, and increased access to patient monitoring, operating theatres, radiology and intensive care beds. Panellists further recommended implementation of injury primary prevention strategies in the community.