Current trends in polytrauma management Diagnostic and therapeutic algorithms operational in the Trauma Center of Cesena, Italy

Abstract

INTRODUCTION: The purpose of this paper is to present the most recent revision of diagnostic therapeutic protocols regarding polytrauma that are operational in the Trauma Center of Cesena, and to check what impact the progressive implementation and review of these algorithms has had on predefined indicators of results and utilization of diagnostic and therapeutic resources. Finally for the purpose of comparing the results obtained in a subgroup of patients treated in the Trauma Center of Cesena, with those obtained in a group homogeneous for ISS and year of hospitalization stored in the RRGT (Registro Regionale Grandi Traumi - Regional Major Trauma Registry).

MATERIALS AND METHODS: Through a retrospective study we analyzed a population of 21,704 patients hospitalized for trauma in our Trauma Center from 2001 to November 2009, 40.1% females and 59.9% males, aged between 0 and 105 years, who were treated with the protocols developed in the Trauma Service. Indicators of results and of diagnostic and therapeutic resource utilization were analyzed. All patients enrolled in the study were divided by year of admission to assess the performance of these indicators over the years. An ISS homogeneous subgroup including only patients hospitalized in the year 2007.was also created for comparison with the report of RRGT (Regional Major Trauma Registry). Emergency Department code yellow or red patients were divided into 3 groups based on the hemodynamic response after primary assessment. Group A included patients that were hemodynamically stable (ATLS criteria); Group B included patients that were hemodynamically stabilized; Group C included patients that were hemodynamically unstable. Each group of patients was treated according to precise diagnostic and therapeutic protocols.

RESULTS: The overall hospital mortality was 2.4%. Mortality at discharge from intensive care was 11.6% while at discharge from the Emergency Surgery was 0.2%. The total average hospital stay was 10.1 days. ICU stay was 7.8 days, while in Emergency Surgery was 12.4 days. 79.4% of the patients were discharged home. Overall, the percentage of patients undergoing surgery was 64.3%. Patients undergoing diagnostic level II with multislice CT were 19.3%; those undergoing CT of the chest and/or abdomen were 5%. A total 0.8% of patients underwent angiography, and 0.2% underwent embolization. The overall percentage of patients transfused with packed red blood cell was 3.9%.

CONCLUSIONS: The hemodynamic response of patients after primary assessment determines the subsequent diagnostic and therapeutic procedures. The protocols that we utilized had a positive impact on the mortality of patients hospitalized in the intensive care and on the average intensive care stay, and were also associated with an increase in the number of angiography and arterial embolizations performed in sicker patients and those with relevant surgical lesions. The decrease in mortality is also observed in comparison with the RRGT data. We believe therefore that these protocols can provide a valuable and effective aid for those involved in the care of trauma victims, allowing them to always be able to quickly decide what to do, when to do, how to do, and where to do what needs to be done.