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ORIGINAL ARTICLE   Open accessopen access

Italian Journal of Emergency Medicine 2020 April;9(1):9-14

DOI: 10.23736/S2532-1285.20.00005-1

Copyright © 2020 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

language: English

Borderline trauma in Trauma Center Hub Maggiore Hospital in Bologna: definition, incidence, pre- and in-hospital management

Antonella LANOTTE 1, Luca ZUCCHINI 1, Mario ANGELINI 2, Evelina REDA 2, Grazia MANCA 2, Chiara CATENA 2, Elisa ROMAGNOLI 3, Lucio BRUGIONI 3

1 Department of Emergency, Maggiore Hospital, Bologna, Italy; 2 Department of Emergency Medicine, University of Modena e Reggio Emilia, Modena, Italy; 3 Medicina Interna Area Critica Unit, Polyclinic of Modena, Modena, Italy

BACKGROUND: The Trauma Center of Maggiore Hospital in Bologna is one of the three HUB centers of the Trauma Integrated System of Assistance to Trauma model (SIAT) in Emilia Romagna, a region of Northern Italy. This hospital employed a specific protocol to manage borderline trauma, from prehospital detection to the in-hospital activation of a specific trauma team, Trauma Team B, guided by emergency physicians.
METHODS: We studied trauma patients centralized from 1 January 2017 to 31 December 2017 to the Emergency Department of Maggiore Hospital in Bologna with code 2 borderline trauma, according to the local protocol. We tested the suitability of borderline trauma criteria analyzing the outcomes as urgent procedure, admission unit and Injury Severity Score and we controlled the adherence to the protocol centralization criteria and diagnostic method and timing.
RESULTS: Data showed a correct activation of Trauma Team B in a high percentage of borderline trauma, subsequently admitted to Emergency Medicine ward. With regard to adherence to the diagnostic-therapeutic assistance pathway our data demonstrated the need to optimize CT timing and to improve the number of first-level exams, as X-rays and EFAST, in the emergency room.
CONCLUSIONS: The study underlined the importance of a correct prehospital identification and centralization of borderline trauma patients in order to give them the best treatment. The study presented some limits related to patient data collection. It evidenced the necessity to promote correct compilation of prehospital emergency service form and to create a common digital form with borderline trauma items to be used in the whole Eastern SIAT area afferent to the Hub trauma center Ospedale Maggiore.

KEY WORDS: Trauma centers; Wounds and injuries; Multiple trauma

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