MATERIA SOCIO MEDICA Vol. 20 • No.4 • 2008 Original papers 212 Original paper SUMMARY GOAL. of the research is to explore the efects of survival or mortality of polytraumatized patients trough initial interaction between revised Trauma Score Scale (RTS) at the level I trauma center. MATERIAL AND METHODS. At the Clinic for emergency medicine of the Clinical Center of Sarajevo University in the period from January 2007 – November 2008 in total 64 polytraumatized patients were treated by the protocol determined for the level I trauma center. During 2007 (N=38); 27 men (71.0%) and 11 women (28.9%). During 2008 (N=26); 20 men (76.9%) and 6 women (23.0%). Study is conducted as retrospective. All necessary parameters for calculation of RTS are inputted into specially designed protocol for polytrauma patients. From the study patients with prehospital intubation were excluded. All ma- terial is statistically processed. RESULTS. Polytraumatized were most often participants in traic N = 46 (71.8%) as follows: pedestrians 18 (28.1%), drivers 12 (18.7%), passengers 12 (18.7%), bikers 2 (3.1%), bicyclists 1 (1.5%) and other passengers 1 (1.5%). Fall from height was present in N = 17 injured (26.5%), ire arms wounds 1 (1.5%). Frequency of injuries with involvement of certain regions/systems was; limbs – spine–pelvis 46 (71.8%), thorax 39 (60.9%), head 38 (59.3%), maxillofacial trauma 10 (15.6%), abdomen 6 (9.3%), blood vessels injuries 3 (4.6%). Calculation of parameters for each injured give the individual RTS values from 0.582 up to 2.779 in 4 cases with lethal outcome, and in two cases lethal outcome with values 5.643 and 7.108. General mortality of polytrauma patients was 9.83 %, with signiicant interaction between polytrauma severity (RTS scale) and level I trauma center (p=0.02). CONCLUSION. In order to reduce mortality and increase survival of the polytrauma patients it is necessary to implement organization model which imply; (1) unique registering of the data, criteria (scoring systems), priorities and routes of care within each health institution in the state with clearly deined hospitals which are capable to react as the levels of trauma centers, (2) conducting the regular monitoring (analytic evaluation and reevaluation) of the complete system by the international surgical associations, (3) to form a service of helicopter transport for urgent medical care with clear determination of polytrauma category which needs the fastest transport by air to the trauma center, taking care about the time factor. Key words; polytrauma, survival, Revised Trauma Score INTRODUCTION 1. Polytrauma is defined as an injury of at least two sy- stems or two different organs, where one of the injuries is life threatening. Its share in the total number of injuries is 3 to 8%, but the mortality rate is extremely high and range from 25 to 35%. Polymorph are the symptoms and with constant change of clinical picture. It is of accident or intentional cause. Usually occurs during traffic acci- dent, falls, fights etc. (1) It is the leading cause of death of Americans under 44 years of life if you exclude cancer and atherosclerosis of all age groups. In care for polytraumatized extremely important is good organizational model of care. It should be available and effective in the shortest time interval from injury. Tendency is toward shorter duration of tissue hipoperfu- sion (prehospital) and harmonization with hospital level of final care (2). Trauma centers are hospital, well-organized and equipped segments that have the primary task in that part of the emergency centers provide all the necessary care for polytraumatized. In performing their tasks in the care for injuries which often require a complex and multidisciplinary medical treatment including surgical which to the injured gives the best chance for survival and recovery. In the USA criteria for qualification of trauma centers as a referral institution for the care of polytraumatized sets American College of Surgeons–ACS. They are assi- gned to each individual center and usually limited to a period of 3 years. (3) Centers vary in their specific ca- pacities and they are marked are designed at the levels of high I, down to low-IV (limited care and stabilization of polytraumatized and his transfer to a higher level of care ). However in the USA there are other operating systems, so for example, in Pennsylvania there is the ranking sy- stem that is based on the criteria of the Commonwealth’s Trauma Foundation. ACS does not officially design the hospitals or trauma centers. Despite this many American hospitals are not on the list of organized trauma centers chain and if they want to present their urgent or trauma unit performances as the level I trauma center or left that to the government authorities citing geopolitical reasons (3). Work of trauma centers is extremely expensive so the Survival Assessment of the Polytraumatized Patients at Level I of Trauma Center Zoran Hadziahmetovic 1 , Izet Masic 2 Clinic for Emergency medicine, Clinical Center of Sarajevo University 1 Faculty of Medicine, Sarajevo University, Bosnia and Herzegovina 2F