@article{ref1,
title="The value of trauma patients' centralization: an analysis of a regional Italian Trauma System performance with TMPM-ICD-9",
journal="Internal and emergency medicine",
year="2021",
author="Ansaloni, Luca and Russo, Emanuele and Gamberini, Emiliano and Coccolini, Federico and Tomasoni, Matteo and Martino, Costanza and Bertoni, Silvia and Agnoletti, Vanni and Fugazzola, Paola",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: In recent years, many studies showed that the Trauma Mortality Probability Model (TMPM-ICD-9) had better calibration compared to other ICD-9-based  models and to the ones based to the Abbreviated Injury Scale (AIS). The study aims  to assess the validity of TMPM-ICD-9 in predicting injury severity in an Italian  region and, through this model, to assess the performances of the Trauma Systems  SIAT Romagna. <br><br>METHODS: Administrative data of trauma patients admitted in the Trauma  System of SIAT Romagna, in Northern Italy, from 2014 to 2018 were obtained. The  XISS, an indirect indicator of Injury Severity Score (ISS) and the TMPM-POD  (Probability of Death) were calculated from ICD-9-CM codes. Only patients with  XISS > 15 were included. Student t-test, Mann-Whitney test and Chi-square test were  used for univariate analyses, while logistic regression for multivariate analyses. <br><br>RESULTS: 3907 trauma patients with XISS > 15 were included. The Hub hospital (HUB)  received 47.1% of these patients. Patients treated in HUB had higher TMPM-POD than  in SPOKE + PST (mean TMPM-POD ± SD: HUB 0.093 ± 0.091, SPOKE + PST 0.082 ± 0.90,  p < 0.027), but only age and sex were significant risk factors for centralization at  multivariate analyses. Higher age (73.1 ± 21.2 vs 66.9 ± 21.2, p < 0.001), higher  XISS (16(9) vs 16(4), p < 0.001) and higher TMPM-POD (0.15 ± 0.14 vs 0.08 ± 0.08,  p < 0.001) resulted significant risk factors for mortality at multivariate analysis. Lower age, higher XISS and lower Trauma Centers (TC) level were significant risk  factors for splenectomy at multivariate analysis. The splenectomy rate was 1.3% in  HUB and of 2.2% in SPOKE + PST (Risk Ratio = 0.4, p = 0.002). <br><br>CONCLUSIONS: Present  analysis proved the validity of TMPM-ICD-9 in predicting mortality of trauma  patients in an Italian region. Furthermore, the usefulness of data extracted from an  administrative database to assess the performance of a TS and the importance of an  adequate centralization process have emerged. Even with a higher TMPM-POD and with  the same mortality rate, HUB showed a higher spleen salvage rate compared to  SPOKE + PST. However, thanks to this model, an improvable centralization process in  SIAT Romagna was found in the study period. Probably, an enhanced centralization  would have improved the spleen salvage rate, which is an important quality indicator  in the evaluation of the performance of the TS.<p /> <p>Language: en</p>",
language="en",
issn="1828-0447",
doi="10.1007/s11739-020-02611-w",
url="http://dx.doi.org/10.1007/s11739-020-02611-w"
}