The relationship between scores and outcomes for polytrauma patients in the emergency department A case study


COD: 02_2017_07_2621 Categorie: ,

Maria Gioffrè-Florio, Letizia Maria Murabito, Carmela Visalli, Alessandra Villari, Floriana Lauritano, Carla Bramanti, Fausto Famà

Ann Ital Chir, 2016 88, 2: 137-142
Epub Ahead of Print 29 Dec. 2016

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AIM: 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.
MATERIAL OF STUDY: 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.
DISCUSSION: 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.