title: The relationship between scores and outcomes for polytrauma patients in the emergency department. A case study.
abstract: OBJECTIVE
  Traumas are one of the most relevant pathological events in health care, because of clinical and prognostic relevance. Morbidity and mortality rates are strongly affected by the timely and correct approach to the patient (golden hour). The objective of this study was to investigate the possible influence of the diagnostic time and of the Injury Severity Score (ISS) on outcomes in trauma patients.
  
  
  METHODS
  Out of a total of 240,833 emergency patients, we observed, 447 polytrauma. All patients were assessed according to the Advanced Trauma Life Support (ATLS) guidelines, diagnosed by computed tomography (CT), and summarized using an adapted complex trauma card (italian version).
  
  
  RESULTS
  Overall, 2.5% (11/447) of patients died during the assessment, whereas the remaining 436 patients were diagnosed at the Emergency room and afterwards hospitalised. In 76 out of 436 patients (17.43%) the outcome was poor. Particularly, the most significant complications involved the central nervous system, chest and abdomen lesions respectively, with an ISS of 41.7 ± 15.9. The mean time for the diagnostic assessment in patients with poor outcome was 115.2 ± 0.4 minutes.
  
  
  CONCLUSIONS
  The immediate mortality percentage, as well as the delayed ones, was highest in patients involved in road accidents. The early management certainly plays a crucial role, reducing death rate and permanent disability.
  
  
  CONCLUSIONS
  The high percentage of patients affected by haemodynamic instability (24.3%) demonstrates the existence of a criticality identifiable in the approach to the patient during the pre-hospital phase: a phase that is dramatically characterised by the exclusion of intensivists from rescue teams.
  
  
  BACKGROUND
  Complex Trauma Card, Mortality, Multiple injuries, Polytrauma, Scores.
authors.forename: Maria Gioffrè
authors.initials: MG
authors.lastname: Florio
authors.forename: Letizia Maria
authors.initials: LM
authors.lastname: Murabito
authors.forename: Carmela
authors.initials: C
authors.lastname: Visalli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Villari
authors.forename: Floriana
authors.initials: F
authors.lastname: Lauritano
authors.forename: Carla
authors.initials: C
authors.lastname: Bramanti
authors.forename: Fausto
authors.initials: F
authors.lastname: Famà
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D017408:Guidelines as Topic; D006801:Humans; D007558:Italy / Q000453:epidemiology; D009104:Multiple Trauma / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods