Diagnostic pathways in major trauma patients admitted to Italian hospitals: survey and discussion points from the trauma update 2019.

Abstract

Major trauma is a leading cause of mortality, morbidity, and disability. Severe trauma patients are taken to hospital with multiple suspected injuries and need urgent diagnosis in order to achieve focused and lifesaving interventions. The primary endpoint of this survey was to evaluate the intrahospital diagnostic paths that trauma patients undergo in Italian hospitals. Thus, during the 14th Italian Trauma Network Congress (Trauma UpDate, Bologna, February 2019), we collected and discussed data from Italian hospitals regarding the usual diagnostic pathway for major trauma patients. Three sets of multiple closed questions, designed to measure the structure, protocols, and habits of Italian hospitals were sent prior to the congress. The questionnaire was developed on the basis of the available literature and expert opinion, regarding: (1) the role of E-FAST, chest and pelvis radiographs in stable major trauma patients; (2) diagnostic pathways after the first-level imaging in major trauma patients, focused on a number of clinical scenarios; (3) diffusion and knowledge of trauma-specific computed tomography (CT) protocols and fast radiologic reporting. We obtained a total of 232 responses to our survey. A remarkable heterogeneity was found between hub and spoke hospitals regarding the indications to the first- and second-level diagnostics, and their use before centralization to trauma centers of patients admitted to peripheral hospitals. Italian hospitals show a high heterogeneity in the diagnostic pathways proposed to major trauma victims, an interdisciplinary revision of local protocols taking into account hospital capabilities, new evidence, and emergency system geographical distribution is strongly recommended.