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Improving the outcome of trauma patients: is it possible in the absence of a trauma system?

Background

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 [1]. Nevertheless, the reorganization of the inhospital trauma care could improve the outcome of major trauma even in absence of a well-designed trauma system.

Methods

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.

Results

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).

Conclusion

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.

References

  1. 1.

    Biffl WL: J Am Coll Surg. 2005, 200: 922-929. 10.1016/j.jamcollsurg.2005.01.014.

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De Blasio, E., Mazzacane, P., Buccarella, A. et al. Improving the outcome of trauma patients: is it possible in the absence of a trauma system?. Crit Care 10, P137 (2006). https://doi.org/10.1186/cc4484

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Keywords

  • Emergency Department
  • Trauma Patient
  • Trauma Center
  • Major Trauma
  • Trauma Care