title: [Impact of an integrated treatment approach of the severely injured patients (ISS =/> 16) on hospital mortality and quality of care].
abstract: BACKGROUND
  Outcome of severely injured patients is sharply influenced by the level of prehospital and hospital organization.
  
  
  OBJECTIVE
  To evaluate the impact of the re-organization of the trauma care process on the quality of care and final outcome of major trauma (ISS =/< 16) victims.
  
  
  METHODS
  the Emergency Department (ED) of a 1600 bedded tertiary care hospital.
  
  
  METHODS
  a standardized approach to major trauma patients (MT) was implemented: Written protocols were established and trauma teams were organized. All anesthesiologists and trauma surgeons involved in trauma care were enrolled in an educational program including ATLS Courses and the Italian Resuscitation Council Prehospital Trauma Care Course. One of the targets was to assure the early orthopedic stabilization of limb and pelvis fractures.
  
  
  METHODS
  Data of all major trauma victims admitted to the ED during 3 comparable periods of time: before (Jan-May 1998), during (Jan-May 1999) and after (Jan-May 2000) the implementation of the process, were retrospectively and prospectively collected and analyzed.
  
  
  RESULTS
  MT patients admitted to the hospital increased from 39 in 1998 to 106 in 2000. For similar ISS (30.2 +/- 11.3 in 1998, 29.6 +/- 13.7 in 1999 and 30.5 +/- 12.9 in 2000) hospital mortality dropped from 42% in 1998 to 20.8%. The mean time from hospital admission to surgical orthopedic stabilization was 12 days in 1998, 4.6 in 1999 and 1.3 in 2000. In 2000, 86% of the patients with limbs fractures who required surgical stabilization, were treated within 36 hours from admission vs 11% in 1998.
  
  
  CONCLUSIONS
  The implementation of written protocols for trauma care, the organization of trauma teams, educational programs including ATLS and PTC-IRC Courses and a strategy of early stabilization of limb fractures are associated with a dramatic decrease in hospital mortality for major trauma.
authors.affiliation: Azienda Ospedaliera S. Camillo-Forlanini, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Nardi
authors.forename: L
authors.initials: L
authors.lastname: Riccioni
authors.forename: E
authors.initials: E
authors.lastname: Cerchiari
authors.forename: E
authors.initials: E
authors.lastname: De Blasio
authors.forename: G
authors.initials: G
authors.lastname: Gristina
authors.forename: M
authors.initials: M
authors.lastname: Oransky
authors.forename: F
authors.initials: F
authors.lastname: Pallotta
authors.forename: C
authors.initials: C
authors.lastname: Ajmone-Cat
authors.forename: C
authors.initials: C
authors.lastname: Freni
authors.forename: S
authors.initials: S
authors.lastname: Trombetta
authors.forename: A M
authors.initials: AM
authors.lastname: Mega
mesh_terms: D004632:Emergency Medical Services / Q000458:organization & administration*; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D019637:Orthopedic Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*