BACKGROUND: In Italy there are no accepted standards for trauma care nor dedicated programs for quality assessment on a national scale, like trauma registries. At the same time there seems to be a north-south gradient in the quality of health care. We hypothesized that geographical inequalities of health-care quality may affect trauma mortality. METHODS: Retrospective comparison of hospital mortality by Cox regression in three main areas of Italy adjusted for age, Glasgow Coma Scale and source of admission. A leading national database on patients admitted to intensive care units (ICU) in the years 2002-2005 was used. 9162 adult trauma cases admitted to the ICU from the emergency department were included. RESULTS: There is a significant north-south gradient of risk. Compared to the north, the risk of death is about 60% higher in the south and about 30% higher in the central region. These figures are similar in both referral centres and other hospitals and both in the head-injured only and total injured cases. CONCLUSION: Despite the limitations of this study, mainly related to sampling issues, risk-adjustment and incomplete follow-up, the large geographic differences in mortality that we found highlight likely deficiencies in the quality of trauma care that deserve further accurate assessment.
BACKGROUND: In Italy there are no accepted standards for trauma care nor dedicated programs for quality assessment on a national scale, like trauma registries. At the same time there seems to be a north-south gradient in the quality of health care. We hypothesized that geographical inequalities of health-care quality may affect trauma mortality. METHODS: Retrospective comparison of hospital mortality by Cox regression in three main areas of Italy adjusted for age, Glasgow Coma Scale and source of admission. A leading national database on patients admitted to intensive care units (ICU) in the years 2002-2005 was used. 9162 adult trauma cases admitted to the ICU from the emergency department were included. RESULTS: There is a significant north-south gradient of risk. Compared to the north, the risk of death is about 60% higher in the south and about 30% higher in the central region. These figures are similar in both referral centres and other hospitals and both in the head-injured only and total injured cases. CONCLUSION: Despite the limitations of this study, mainly related to sampling issues, risk-adjustment and incomplete follow-up, the large geographic differences in mortality that we found highlight likely deficiencies in the quality of trauma care that deserve further accurate assessment.
Authors: Ellen J MacKenzie; Frederick P Rivara; Gregory J Jurkovich; Avery B Nathens; Katherine P Frey; Brian L Egleston; David S Salkever; Daniel O Scharfstein Journal: N Engl J Med Date: 2006-01-26 Impact factor: 91.245
Authors: S Boffelli; C Rossi; A Anghileri; M Giardino; L Carnevale; M Messina; M Neri; M Langer; G Bertolini Journal: Minerva Anestesiol Date: 2006-06 Impact factor: 3.051
Authors: James L Guzzo; Grant V Bochicchio; Lena M Napolitano; Debra L Malone; Walter Meyer; Thomas M Scalea Journal: J Am Coll Surg Date: 2005-10-13 Impact factor: 6.113
Authors: Demetrios Demetriades; Eric Kuncir; James Murray; George C Velmahos; Peter Rhee; Linda Chan Journal: J Am Coll Surg Date: 2004-08 Impact factor: 6.113