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Objectives: To assess the appropriateness of arterial carbon dioxide tension control in a group of 92 patients with traumatic brain injury who, despite receiving advanced prehospital care, showed no improved outcome in comparison with a group homogeneous but for a lower level of prehospital care. Methods: A retrospective registration of the early in-hospital arterial carbon dioxide tension of the patients intubated and ventilated on scene. Patients were excluded if the arterial carbon dioxide tension did not reflect prehospital ventilation or its alteration might have been intentional or unavoidable. Results: Arterial carbon dioxide tension was normal (35-45 mmHg) in only six of the 16 suitable cases (37.5%), was elevated (>45 mmHg) in three cases (18.75%), low (25-35 mmHg) in five cases (31.25%), and extremely low (

Objective To describe and discuss the ongoing endeavor to establish a multiregional trauma registry in Italy. Methods Design: Prospective observational analysis by description and cohort comparison. Setting: Three Italian hospitals, referral centers for severely traumatized patients. Patients: trauma victims admitted between 1 July 2004 and 28 February 2005 with an Injury Severity Score >15 or requiring early admission to intensive care. Interventions: None. Measures: Compilation rates for some 'sentry' variables. Total number of patients and Injury Severity Score. Ten widely used descriptive variables (type of trauma, mechanism of injury, age, gender, Injury Severity Score, Revised Trauma Score, Prognostic Severity Index, 'call-to-hospital' and 'admission-to-ward' intervals, and outcome at 30 days) measured in the subgroup with Injury Severity Score >15, in general and by hospital. Results A trauma registry has been established that fit the present organization of trauma care in Italy. It seems to compare well with the references available in the literature. Five hundred and forty-nine patients have been enrolled so far. The compilation rate has been well above 70% for all variables in all hospitals, except pre-hospital times in two hospitals. A substantial homogeneity exists among the hospitals in the general characteristics of the patients with Injury Severity Score >15. Conclusions The project has achieved its goals so far. The previous estimates on the number of cases (about 300/year/hospital) are confirmed and major shortcomings in methodology seem unlikely. Therefore, positive future developments are possible: usage for quality improvement and research, linkage to other European registries and participation of other hospitals.

Objective. To assess whether a top-level type of prehospital care, made of helicopter, physician, and advanced life support (ALS) procedures, improves the outcome of blunt trauma victims found in cardiac arrest (CA) as compared with a simpler type, composed of ground ambulance, nurse, and expanded basic life support (BLS). Methods. This was a cohort study from the data set of a prospective, population-based, 12-month study targeting the 1,200,000 inhabitants of the Italian region Friuli Venezia Giulia. Results. Fifty-six victims received the higher level of care (helicopter emergency medical services [HEMS] group) and 73 received the lower one (ground-BLS group). The two groups were homogeneous for mechanism of injury, gender, and time interval before cardiopulmonary resuscitation (CPR). Age was lower in the ground-BLS group. The percentage of patients in which CPR was attempted was significantly higher in the HEMS group (43% vs. 20%; CI 0.061 to 0.379). On-scene return of spontaneous circulation (ROSC) was also more likely in the HEMS group (37.5% of attempted CPRs vs. 6.6%; CI 0.027 to 0.591). None of the patients evacuated from the scene without ROSC ever attained it in hospital. This policy was virtually exclusive to the ground-BLS group. Survival to hospital discharge was 3.5% (severely disabled) in the HEMS group and 0% in the ground-BLS group (CI -0.008 to 0.078). Conclusion. A top-level type of prehospital care had significantly more chances to resuscitate blunt trauma victims found in CA as compared with a simpler level. No significant benefit on long-term outcome was found, but more cases might be needed in future studies because of the inevitably low number of survivors.

Objective: To provide reliable and comparable information on major injury (MIJ) (Injury Severity Score (ISS)>15) by establishing a comprehensive and Utstein-style compliant registry of all occurrences in a defined geographical area. Methods: Prospective, population-based, 12-month study targeting the 1,200,000 inhabitants of the Italian region Friuli Venezia Giulia (FVG). Deliberate self-harm was excluded. Results: The total number of MIJ cases was 627, the resulting incidence 522 per million per year. Trauma was mostly blunt (98.4%). Young (15-44 years) adults (54.8%) and males (78.6%) were most affected. Leading mechanisms of injury were traffic accidents (81%) and falls (9.1%). Most events occurred in rural (80.9%) areas despite one third of the regional population living in major urban centres. Summer and weekends carried the highest frequency. The mean ISS (n=455) was 30.0, median 25. On-scene vital parameters were often subnormal, e.g. 53.9%, GCS

BACKGROUND: Pneumothorax (PNX) is a recognized cause of preventable deaths in trauma patients. Our objective was to determine the incidence of traumatic PNX, the characteristics of its victims, and the treatment they receive. METHODS: The study consisted of data set of a population-based study on major trauma. RESULTS: The incidence of PNX was 81 per 1 million population per year, mostly caused by transport accidents. PNX victims generally had multiple injuries, and they showed on-scene clinical parameters worse than victims of other chest injuries of comparable severity. Fifty-three percent of PNXs were drained during the prehospital and early (< 2 hours) hospital course. There was no uniformity of treatment among different types of rescue facilities, some of them never performing decompression despite clinical need. The z statistic for mortality was -0.63. CONCLUSION: PNX can be expected in one in five major trauma victims found alive. PNX is associated with a peculiar on-scene instability. Early decompression is often required. The effects of wider access to prehospital decompression and the reasons for its uneven availability in our setting need elucidation. Nevertheless, the present mortality follows the international standards.