How formative courses about damage control surgery and non-operative management improved outcome and survival in unstable politrauma patients in a Mountain Trauma Center

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COD: 01_2016_1199_2426 Categorie: ,

Giovanni Bellanova, Francesco Buccelletti, Riccardo Berletti, Marco Cavana, Giorgio Folgheraiter, Francesca Groppo, Chiara Marchetti, Amelia Marzano, Alessandro Massè, Antonio Musetti, Tina Pelanda, Nicola Ricci, Gregorio Tugnoli, Damiano Papadia, Claudio Ramponi

Ann. Ital. Chir., 2016 87: 68-74

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AIM: 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.
MATERIAL OF STUDY: 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). DISCUSSION: 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.