How formative courses about damage control surgery and non-operative management improved outcome and survival in unstable politrauma patients in a Mountain Trauma Center

Aim of this study is to analyze how the starting of Course of Trauma in our hospital improved survival and organization in management of polytraumatized patients. We analysed all major trauma patients (Injury Severity Score (Injury Severity Score (ISS)> 15) treated at Emergency Department of the...

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Bibliographic Details
Published in:	Annali italiani di chirurgia Vol. 87; p. 68
Main Authors:	Bellanova, Giovanni, Buccelletti, Francesco, Berletti, Riccardo, Cavana, Marco, Folgheraiter, Giorgio, Groppo, Francesca, Marchetti, Chiara, Marzano, Amelia, Massè, Alessandro, Musetti, Antonio, Pelanda, Tina, Ricci, Nicola, Tugnoli, Gregorio, Papadia, Damiano, Ramponi, Claudio
Format:	Journal Article
Language:	English
Published:	Italy 2016
Subjects:	Blood Transfusion - statistics & numerical data Conservative Treatment - statistics & numerical data Diagnostic Imaging - statistics & numerical data Disease Management Education, Medical, Continuing Emergencies Emergency Medicine - education Emergency Service, Hospital - organization & administration Emergency Service, Hospital - statistics & numerical data Hospital Mortality Humans Injury Severity Score Multiple Trauma - mortality Multiple Trauma - surgery Multiple Trauma - therapy Organizational Policy Practice Guidelines as Topic Surgical Procedures, Operative - statistics & numerical data Time-to-Treatment Trauma Centers - organization & administration Trauma Centers - statistics & numerical data Treatment Outcome Unnecessary Procedures
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Summary:	Aim of this study is to analyze how the starting of Course of Trauma in our hospital improved survival and organization in management of polytraumatized patients. We analysed all major trauma patients (Injury Severity Score (Injury Severity Score (ISS)> 15) treated at Emergency Department of the Santa Chiara Hospital between January 2011 and December 2014. The training courses (TC) were named "management of polytrauma" (MP) and "clinical cases discussion" (CCD), and started in November 2013. We divided the patients between two groups: before November 2013 (pre-TC group) and after November 2013 (post-TC group). MTG's courses (EMC accredited), CCD and MP courses started in November 2013. The target of these courses was the multidisciplinary management of polytrauma patient; the courses were addressed to general surgeons, anaesthesiologists, radiologists, orthopaedics and emergency physicians. Respectively 110 and 78 doctors were formed in CCD's and MP's courses. Patients directly transported to our trauma centre rose from 67.5% to 83% (p<0,005), and E-FAST grew from 15.6% in the pre-TC group to 51.3% in the post-TC group. Time of access in operatory theatre decreased from 62 to 44 minutes. Early Mortality (within 48 hours from the hospital arrival) was 9% in the pre-TC group and 4.5% in the post-tc group (p<0.005). Be needed to complete our goal. Further analysis and possible comparison with other trauma centers be needed to complete our goal Our results show that in our experience the multidisciplinary approach to polytrauma patients increased early survival and improved outcome with an evidence of worker's satisfaction. However, the best practice would ask to start with the approval of procedures and guidelines by the hospital governance, followed by clinical practice changes, in order to create a dedicated emergency and trauma surgery group. Damage Control Surgery, Non Operative Management, Trauma Course, Trauma Team, Trauma Center.
ISSN:	2239-253X