Vol.:(0123456789) 1 3 Eur J Trauma Emerg Surg DOI 10.1007/s00068-017-0873-8 ORIGINAL ARTICLE Trauma patients centralization for the mechanism of trauma: old questions without answers S. Magnone 1  · A. Ghirardi 2  · M. Ceresoli 1  · L. Ansaloni 1   Received: 11 July 2017 / Accepted: 4 November 2017 © Springer-Verlag GmbH Germany, part of Springer Nature 2017 Conclusions Signifcant association with major trauma was demonstrated in the multivariate analysis of diferent mechanisms of trauma in patients triaged only for dynam- ics. A revision of our feld triage protocol with a prospective validation is needed to improve overtriage that is above the suggested limits. Keywords Trauma centres · Injury Severity Score · Triage · Multiple trauma · Mechanism of injury Introduction Traumatic injuries usually ask for demanding organisa- tion both for time-related needs and a comprehensive and immediate multidisciplinary approach to reach acceptable outcomes [1, 2]. Moreover, regionalisation of trauma care has proved better results regarding mortality [3]. In Lom- bardia Region, Italy, a trauma system was established in October 2012 [4], aiming at the creation of six Level I Trauma centres, connected with several other hospitals as lower level centres. No standard monitoring or regulations for the managing of data exist in Italy, as well as in Lom- bardia in the north part of the State. Lombardia is a 10 mil- lion inhabitants region and has four Emergency Medical System (EMS) control rooms. Bergamo province is in the middle of the region and accounts for a 1.1 million popu- lation served by the Papa Giovanni XXIII Hospital, the only Level I-II Trauma Centre with neurosurgery, which is the referral for unstable patients also for the Sondrio province (further 181,000 inhabitants), and it holds one of the EMS control rooms. At the beginning of our experi- ence overtriage was the main concern of the feld triage protocol because it could wear out the Trauma Team and the Emergency Department. Moreover, trauma care has Abstract Introduction Centralization of trauma patients has become the standard of care. Unfortunately, overtriage can overcome the capability of Trauma Centres. This study aims to ana- lyse the association of diferent mechanisms of injury with severe or major trauma defned as Injury Severity Score (ISS) greater than 15 and an estimation of overtriage upon our Trauma Centre. Methods A retrospective review of our prospective data- base was undertaken from March 2014 to August 2016. Uni- variate and multivariable logistic regression models were used to estimate the association between covariates (gender, age, and mechanisms of injury) and the risk of major trauma. Results The trauma team (TT) treated 1575 patients: among the 1359 (86%) were triaged only because of dynam- ics or mechanism of trauma. Overtriage according to an ISS < 15, was 74.6% on all trauma team activation (TTA) and 83.2% among the TTA prompted by the mechanism of injury. Patients aged 56–70 years had an 87% higher risk of having a major trauma than younger patients (OR 1.87, 95% CI 1.29–2.71) while for patients aged more than 71 years OR was 3.45, 95% CI 2.31–5.15. Car head-on collision (OR 2.50, 95% CI 1.27–4.92), intentional falls (OR 5.61, 95% CI 2.43–12.97), motorbike crash (OR 1.67, 95% CI 1.06–2.65) and pedestrian impact (OR 2.68, 95% CI 1.51–4.74) were signifcantly associated with a higher risk of major trauma in a multivariate analysis. * S. Magnone smagnone@asst-pg23.it 1 General Surgery Unit, Ospedale Papa Giovani XXIII, Piazza OMS 1, 24127 Bergamo, Italy 2 FROM Research Foundation, Papa Giovanni XXIII Hospital, Bergamo, Italy