title: How formative courses about damage control surgery and non-operative management improved outcome and survival in unstable politrauma patients in a Mountain Trauma Center.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  Be needed to complete our goal. Further analysis and possible comparison with other trauma centers be needed to complete our goal
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Damage Control Surgery, Non Operative Management, Trauma Course, Trauma Team, Trauma Center.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Bellanova
authors.forename: Francesco
authors.initials: F
authors.lastname: Buccelletti
authors.forename: Riccardo
authors.initials: R
authors.lastname: Berletti
authors.forename: Marco
authors.initials: M
authors.lastname: Cavana
authors.forename: Giorgio
authors.initials: G
authors.lastname: Folgheraiter
authors.forename: Francesca
authors.initials: F
authors.lastname: Groppo
authors.forename: Chiara
authors.initials: C
authors.lastname: Marchetti
authors.forename: Amelia
authors.initials: A
authors.lastname: Marzano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Massè
authors.forename: Antonio
authors.initials: A
authors.lastname: Musetti
authors.forename: Tina
authors.initials: T
authors.lastname: Pelanda
authors.forename: Nicola
authors.initials: N
authors.lastname: Ricci
authors.forename: Gregorio
authors.initials: G
authors.lastname: Tugnoli
authors.forename: Damiano
authors.initials: D
authors.lastname: Papadia
authors.forename: Claudio
authors.initials: C
authors.lastname: Ramponi
mesh_terms: D001803:Blood Transfusion / Q000706:statistics & numerical data; D000072700:Conservative Treatment / Q000706:statistics & numerical data*; D003952:Diagnostic Imaging / Q000706:statistics & numerical data; D019468:Disease Management; D004502:Education, Medical, Continuing; D004630:Emergencies; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D061665:Time-to-Treatment; D014193:Trauma Centers / Q000458:organization & administration / Q000706:statistics & numerical data; D016896:Treatment Outcome; D019564:Unnecessary Procedures