Ulus Travma Acil Cerrahi Derg. 2016; 22(3): 242-246 | DOI: 10.5505/tjtes.2015.19540

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

Stefano Magnone¹, Andrea Allegri¹, Eugenia Belotti², Claudio Carlo Castelli³, Marco Ceresoli¹, Federico Coccolini¹, Roberto Manfredi¹, Cecilia Merli², Fabrizio Palamara¹, Dario Piazzalunga¹, Tino Martino Valetti⁴, Luca Ansaloni^1
1General Surgery I Pope John Xxiii Hospital Bergamo Italy
²Emergency Medicine Department Pope John Xxiii Hospital Bergamo Italy
³Orthopedics Department Pope John Hospital Xxiii Bergamo Italy
⁴Intensive Care Unit Pope John Hospital Xxiii Bergamo Italy

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).
CONCLUSION: 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.

Keywords: Advanced trauma life support, fatal outcome, trauma centers, trauma system; trauma team.

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Yoðun bir metropol hastanesinde aðýr travmada 24 saat içindeki ölüm oranlarýna ATLS kýlavuzlarýnýn ve travma ekibinin etkisi: Bir olgu kontrollü çalýþma

Stefano Magnone¹, Andrea Allegri¹, Eugenia Belotti², Claudio Carlo Castelli³, Marco Ceresoli¹, Federico Coccolini¹, Roberto Manfredi¹, Cecilia Merli², Fabrizio Palamara¹, Dario Piazzalunga¹, Tino Martino Valetti⁴, Luca Ansaloni^1
1Papa 23. John Hastanesi, 1. Genel Cerrahi Kliniði, Bergamo, Ýtalya
²Papa 23. John Hastanesi, Acil Týp Kliniði, Bergamo, Ýtalya
³Papa 23. John Hastanesi, Ortopedi Kliniði, Bergamo, Ýtalya
⁴Papa 23. John Hastanesi, Yoðun Bakým Ünitesi, Bergamo, Ýtalya

AMAÇ: Travma hastalarýnýn baþlangýç tedavisinde ATLS kýlavuzlarý geniþ ölçüde kabul görmüþtür. Hastanemiz Nisan 2011’de ATLS ve travma ekibi uygulamasýný baþlatmýþtýr. Bu çalýþmanýn amaçlarý þok odasýnda ve kabulden sonraki 24 saat içinde ölüm oranlarýndaki deðiþiklikleri deðerlendirmektir.
GEREÇ VE YÖNTEM: Travma sonrasý en az 48 saat içindeki hasta kabullerinin kaydedildiði idarenin bilgisayar yazýlýmýndan hastalara ait veriler alýndý. Çalýþma dönemi Nisan 2011 ila Aralýk 2012 ve kontrol dönemi Ocak 2007 ila Mart 2011 arasý idi. Kabul edilen hastalarýn tümü ilk tanýlarýna (ICD 9-CM) göre tanýmlandý, travmatik beyin travmalarý dýþlandý, yalnýzca genel yoðun bakým ünitesi, genel cerrahi ve ortopediye kabul edilen hastalar göz önüne alýndý.
BULGULAR: Kontrol grubunda (KG) 198, çalýþma grubunda (ÇG) ise 141 hasta vardý. Ýki grup cinsiyet, hastanede yatýþ süresi ve Travma Þiddet Derecesi Skoru açýsýndan benzer olmasýna raðmen yaþlarý farklýydý (yaþ ortalamalarý: KG, 45.2±19.2 yýl ve ÇG 49.3±18.3 yýl [p=0.03]). Ýki grupta eks olan hastalarda sistolik kan basýncý, metabolik asidoz veya eritrosit süspansiyonu kullanýmý açýsýndan herhangi bir fark yoktu. Kontrol grubunda ölüm oranlarý anlamlý derecede daha yüksekti (KG 1 %4.1, ÇG, %7,1; p=0.033, Güven Aralýðý [GA] 0.21–0.95). Þok odasýnda mortalite çalýþma grubunda anlamlý derecede daha düþüktü (ÇG, %0.7 ve KG, %7.1 (p=0.002, GA 0.004–0.592).
TARTIÞMA: Hem þok odasýnda hem de hastaneye kabul sonrasý ATLS kýlavuzlarý ve travma ekibinin kullanýlmaya baþlanmasý hem þok odasýnda hem de hastaneye kabulden sonraki ilk 24 saat içindeki mortaliteyi azaltmýþtýr.

Anahtar Kelimeler: Ölümcül sonuç, travma ekibi, travmada ileri yaþam desteði, travma merkezleri; travma sistemi.

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