Defining ''dead on arrival'': Impact on a Level I trauma center

Objective: To determine the potential impact of defining criteria for ''dead on arrival'' (DOA) on a Level I trauma center. Methods: From 1990 to 1994, trauma patients having cardiopulmonary resuscitation (CPR) performed by certified prehospitial personnel were received for time of CPR, outcome, and costs to determine whether any benefit would have been realized had DOA criteria been followed. Results: A total of 106 patients had prehospital CPR; 20 did not meet DOA criteria and underwent resuscitation, three survived (15%). Eighty-six patients met DOA criteria; 16 were pronounced dead without further resuscitative efforts (in-hospital costs of $200/patient), while 70 (81%) had continued resuscitation with no survivors (in-hospital costs of $4150/patient). The positive predictive value for criteria was 100%. Had criteria been implemented, total cost savings over the 5-year period would have been $290,000. Conclusions: National DOA criteria could dramatically reduce the burden on trauma centers with an estimated minimum annual savings of $14 million.