Improving the outcome of trauma patients: is it possible in the absence of a trauma system?
© BioMed Central Ltd 2006
Published: 21 March 2006
It is widely accepted that planning a trauma system, which allows the centralization of major trauma to the trauma centers with a high volume of activity, is able to reduce the mortality of trauma . Nevertheless, the reorganization of the inhospital trauma care could improve the outcome of major trauma even in absence of a well-designed trauma system.
Retrospective evaluation of the impact on outcome of a standardized approach to the trauma patients admitted to a general ICU in an 450-bed hospital not designated as a trauma center. The interventions adopted were the following:
Specific training of all the physicians and the nurses involved in the trauma care in the Emergency Department and the ICU.
Formal adoption of the team approach for trauma patients and of specific guidelines for the diagnostic and therapeutic pathway in the Emergency Department.
Agreement between the prehospital and inhospital trauma teams on the clinical and dynamic criteria used to alert the trauma team in the field.
Formal adoption of specific therapeutic protocols for the trauma patient in the ICU.
The data of 1 year of activity, before, during and after the interventions, were collected and analyzed with the chi-square test.
There was an increase of the number of patients from 44 to 69 and 66 per year without differences in the mean age (38.8 ± 21.6, 38.2 ± 18.8 and 42.2 ± 22.6 years) and severity scores (SAPS II: 30.2 ± 14.2, 31.4 ± 14.3, 31.4 ± 12.8; ISS: 29.2 ± 12.1, 28.2 ± 12.0, 29.6 ± 11.9), respectively, in 2003, 2004, and 2005. There was a progressive increase of the use of some therapeutic techniques, such as FAST and the CT study of the C-spine in the Emergency Department and non-invasive ventilation and ultrafiltration in ICU. The mortality showed a reduction from 36.3% in 2003 to 24.6% in 2004 and 17.2% in 2005, with a statistically significant difference between 2003 and 2005 (P = 0.034).
A reorganization of the response of the hospital to the trauma could improve the outcome even in the absence of a trauma system and a high volume of activity.