Impact of ATLS guidelines, trauma team introduction, and 24-hour mortality due to severe trauma in a busy, metropolitan Italian hospital: A case control study.
BACKGROUND
Advanced Trauma Life Support (ATLS) guidelines are widely accepted for use in initial management of trauma patients. The application of ATLS guidelines and introduction of management by means of trauma team (TT) both took place in April 2011. The aim of the present study was to evaluate related effects on mortality in the shock room (SR) and at 24 hours after admission.


METHODS
Data were retrieved by administrative software based on patient admission for trauma of at least 48 hours. Study period was from April 2011 to December 2012, and control period was from January 2007 to March 2011. All admitted patients were identified by first diagnosis (ICD 9-CM), excluding traumatic brain injuries, and only patients admitted to the general intensive care, general surgery, and orthopedics units were included.


RESULTS
The control group (CG) included 198 patients; the study group (SG) included 141. Differences were determined in patient age, which was mean 45.2 years (SD: 19.2) in the CG and mean 49.3 years (SD±18.3) in the SG (p=0.03). Differences were not found regarding gender, length of hospital stay, or Injury Severity Score (ISS). Among the patients who died, no differences were found in terms of systolic blood pressure, metabolic acidosis, or packed red blood cell consumption. Mortality was significantly higher in the CG, compared to the SG (14.1% vs 7.1%, respectively; p=0.033; confidence interval [CI]: 0.21-0.95). Mortality in the shock room was significantly lower in the SG, compared to the CG (0.7% vs 7.1%, respectively; p=0.002; CI: 0.004-0.592).


CONCLUSIONS
The introduction of ATLS guidelines and TT had a positive impact on mortality in the first 24 hours, both in the SR and after admission.
Department of General Surgery I, Pope John XXIII Hospital, Bergamo-Italy. smagnone@hpg23.it.
Stefano
S
Magnone
Department of General Surgery I, Pope John XXIII Hospital, Bergamo-Italy.
Andrea
A
Allegri
Department of Emergency Medicine, Pope John XXIII Hospital, Bergamo-Italy.
Eugenia
E
Belotti
Department of Orthopeadics, Pope John Hospital XXIII, Bergamo-Italy.
Claudio Carlo
CC
Castelli
Department of General Surgery I, Pope John XXIII Hospital, Bergamo-Italy.
Marco
M
Ceresoli
Department of General Surgery I, Pope John XXIII Hospital, Bergamo-Italy.
Federico
F
Coccolini
Department of General Surgery I, Pope John XXIII Hospital, Bergamo-Italy.
Roberto
R
Manfredi
Department of Emergency Medicine, Pope John XXIII Hospital, Bergamo-Italy.
Cecilia
C
Merli
Department of General Surgery I, Pope John XXIII Hospital, Bergamo-Italy.
Fabrizio
F
Palamara
Department of General Surgery I, Pope John XXIII Hospital, Bergamo-Italy.
Dario
D
Piazzalunga
Department of Intensive Care Unit, Pope John Hospital XXIII, Bergamo-Italy.
Tino Martino
TM
Valetti
Department of General Surgery I, Pope John XXIII Hospital, Bergamo-Italy.
Luca
L
Ansaloni
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003422:Critical Care; D019091:Critical Pathways; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000401:mortality* / Q000473:pathology / Q000601:surgery