Hospital In Florence Research Articles

Influence of assisted reproductive technologies on maternal and neonatal outcomes in early preterm deliveries

IntroductionCompared to spontaneous conception (SC), pregnancies conceived through assisted reproductive technologies (ART) carry worse pregnancy and neonatal outcomes. Evidences focused on preterm births are limited. Early preterm delivery is a critical situation for medical management and parental counselling. The aim of this study was to analyze if ART procedures influenced pregnancy and neonatal outcomes in singleton pregnancies with early preterm delivery. Material and methodsThis was a retrospective case control study. The population consisted of all consecutive early preterm deliveries occurred at Careggi University Hospital in Florence (Italy) between 2010 and 2017. Cases were considered patients who conceived though ART, including intra cytoplasmic sperm injection (ICSI), in vitro fertilization and embryo transfer (IVF-ET), intra uterine insemination (IUI) and ovarian stimulation. Controls were patients who conceived in the natural way.Main outcomes of the study were: birth weight, umbilical artery pH, Apgar score at 1 and 5 min, gestational age at delivery and mode of delivery.Secondary outcomes were: spontaneous preterm labor initiation, gestational diabetes mellitus, intrauterine growth restriction (IUGR), cholestasis of pregnancy, intra uterine fetal demise (IUFD), placenta previa, fetal malformations, pregnancy induced hypertensive (PIH) disorders (gestational hypertension, preeclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome) and postpartum hysterectomy.Shapiro-Wilk test was used to check the normality of the data; Mann-Whitney test was used to compare two continuous variables not-normally distributed. Multiple and binomial logistic regression analyses were used to adjust the results of the statistical analysis for potential confounding factors. The analysis for the main outcomes was performed for all deliveries and then repeated for spontaneous deliveries, separately. ResultsSeventy-one patients had ART and 640 SC. We found no differences in birthweight, umbilical artery pH, Apgar at 1 and 5 min and gestational age at delivery between ART and SC groups. C-section rate, placenta previa and PIH disorders were higher in the ART group. The higher prevalence of C-sections in the ART group was not statistically significant after adjusting for age and parity in the whole population but resulted significantly different when analyzing the subgroup of patients with spontaneous initiation of labor. ConclusionsFetal outcomes seem to be equal between ART and SC in early preterm neonates ; C-section rate and pregnancy complications such as placenta previa and PIH disorders seem to be higher in the ART group. These information should be part of the family counselling in these cases. We suggest that clinicians, after management of preterm delivery had been properly addressed, should not apply different management in ART compared to SC pregnancies.

Activities of an ECMO Center for Severe Respiratory Failure: ECMO Retrieval and Beyond, A 4-Year Experience

Beyond retrieval and management of patients with severe acute respiratory distress syndrome, an extracorporeal membrane oxygenation (ECMO) center also encompasses several other actions, such as on-call consultations, advice, and counseling, to the physicians at the peripheral centers, but few data are available on this topic. Therefore, the authors describe the composite activities of retrieval and counseling of an ECMO center since 2014. The referral calls addressed to the authors' ECMO center for patients with respiratory failure were prospectively recorded in a dedicated database. Referral call frequency, patient data, and results of the calls were analyzed. The 12-bed intensive care unit of Careggi Hospital in Florence, the ECMO referral center for Tuscany, and the center of Italy, with a mobile ECMO team. Patients from intensive care units of peripheral hospitals for whom a referral call was addressed to the authors' ECMO center. Many possible responses were given after a referral call, varying from ECMO team deployment to advice or to refusal. From January 1, 2014, to December 31, 2017, 231 calls were received at the authors' ECMO center, of which 220 calls were for acute respiratory failure cases. Throughout the study period the overall number of calls did not vary, but the percentage of ECMO retrievals decreased, whereas the percentage of ARF patients from peripheral hospital admitted to our ECMO center on conventional ventilation increased. Fifty-five patients were treated by the mobile ECMO team and were transferred on ECMO; 59 were admitted on ventilatory support. In flu periods the overall calls were more frequent than in the no-flu periods (171 v 82 calls), and more ECMO retrieval missions were deployed. During the study period, a decreased number of patients retrieved on ECMO was observed, whereas patients transferred on ventilation increased, with an overall unchanged number of referred patients.

Continuum of care among HIV-1 positive patients in a single center in Italy (2007-2017).

AimThis study aimed to determine rates of retention in care, viral suppression, and use of antiretroviral therapy (ART) and identify risk factors for loss to follow-up (FU) in an adult cohort from a tertiary teaching hospital in Florence, Italy.MethodsWe included all newly diagnosed HIV-infected patients aged >18 years who were linked to our clinic from July 2007 to December 2015. On July 31, 2017, we evaluated the proportion of patients retained in care, on ART, and having HIV RNA <50 copies/mL. We assessed predictors of loss to FU through univariate and multivariate analyses.ResultsWe included 423 patients. By July 2017, 23 (5.5%) patients died, 25 (5.9%) moved to a different center, and 64 (15.1%) were lost to follow-up. Among the remaining 311 patients (73.5%), 96.5% were on ART and 95% had HIV RNA <50 copies/mL. After adjustment for sex, age at diagnosis, origin, and risk of transmission, our results showed a lower retention rate in those not on ART at the end of the follow-up (adjusted HR [aHR]: 10.33, 95% CI 5.80–18.40, P<0.001), non-Italians (aHR: 1.69, 95% CI: 0.99–2.89, P=0.054) and <35 years old (aHR: 1.85; 95% CI 1.04–3.30, P=0.037).ConclusionIn our hospital in Florence, we found a gap in retention in care among foreigners, people <35 years old, and those who were not in treatment at the end of the follow-up. The results of this study may help to identify opportunities for appropriate future interventions.

Indication of prophylactic vaccines as a tool for secondary prevention in HPV-linked disease.

To determine whether quadrivalent HPV vaccination is effective in reducing recurrent disease in women with a previous history of HPV disease. All women under 45years of age treated for HPV-linked disease and with negative HPV test, cytology and colposcopy 3months after treatment were enrolled. Women were randomly assigned into two groups: a group that received HPV vaccine post treatment and a group that was only submitted to follow-up. Follow-up was performed every 6months for a duration of at least 3years. Kaplan-Meier curve was used to estimate the overall disease-free survival during the follow-up period. Statistical analysis was performed by Fisher's exact test. From November 2013 to October 2014, we enrolled a total of 178 women at Careggi University Hospital in Florence and at Azienda USL in Massa Carrara. 12 out of 89 patients in the non-vaccination group recurred (13.5%), while 3 out of 89 patients in the vaccination group recurred (3.4%). The Kaplan-Meier curves showed a statistically difference in the log rank test (p = 0.0147) for the overall disease-free survival in the study groups during follow-up. The rate of recurrence was significantly higher in the non-vaccination group, with a p = 0.0279 by Fisher exact test. The introduction of anti-HPV vaccination during the follow-up post treatment for HPV-linked disease is recommended to reduce the risk of recurrence. The clinical implication of this could be very important to influence post-treatment management of HPV disease.

Peripapillary comet lesions and comet rain in PXE-related retinopathy.

To study peripapillary comet lesions (PCL) in Italian patients affected with pseudoxanthoma elasticum (PXE). Retrospective review of fundoscopic and swept-source (SS) optical coherence tomography (OCT) images of patients with PXE examined at the Regional Reference Center for Hereditary Retinal Degenerations at the Careggi Teaching Hospital of Florence from 2012 to 2017. From 148 eyes of 74 patients affected with PXE, we identified 24 eyes of 14 patients (11 were female) with a mean age of 39years (range, 20-58years) characterized by peripapillary comet lesions. Of these 24 eyes, 15 eyes (of 10 patients) were characterized by comet rain. The smallest comet lesion at the OCT examination appeared as a focal roundish hyper-reflective alteration at the level of the outer retinal segments and RPE-Bruch's membrane complex; the larger lesions appeared as circular and ovoid structures with hyper-reflective borders in the outer nuclear layer. The comet lesion formation process involves the outer layers of the retina and RPE/Bruch's membrane complex. It consists of a degenerative/rearrangement process of the photoreceptors which occurs in an area of focal altered RPE/Bruch's membrane resembling the outer retinal tubulation.

Long-term efficacy of add-on lacosamide treatment in children and adolescents with refractory epilepsies: A single-center observational study.

To assess long-term efficacy and tolerability of lacosamide (LCM) as adjunctive treatment through a retrospective study in children and adolescents with refractory epilepsies. All patients consecutively treated with LCM as add-on for refractory focal and generalized epilepsy and followed at the Neuroscience Center of Excellence of the Meyer Children's Hospital of Florence between January 2011 and September 2015 were included in the study. Responder rate, relapse-free survival, and retention rate were calculated. Tolerability was assessed by reporting adverse events. A total of 88 individuals (41 female) aged 4months to 18years (median 10.5years; mean±SD 10.6±4.8years) received add-on LCM treatment for refractory epilepsy. Thirty-four patients (38.6%) were responders with a median time to relapse of 48months. Nine (26.4%) of the 34 responders were seizure-free. For all 88 patients, the probability of remaining on LCM without additional therapy was 74.4% at 6months, 47.7% at 12months, 27.9% at 24months, 18.0% at 48months, and 8.2% at 72months of follow-up. No statistically significant differences in relapse and retention time were observed with regard to epilepsy and seizure types, duration and course of epilepsy, number and type of antiepileptic drugs (AEDs; sodium channel blockers vs others) used in add-on. The most frequent adverse events were dermatological (4/11) and behavioral (3/11). This study documents a real-world progressive and significant loss of LCM efficacy over time in a pediatric population. Further prospective studies on larger populations are required to confirm the remarkable loss of LCM efficacy over time.

Is hepatitis B vaccination performed at infant and adolescent age able to provide long-term immunological memory? An observational study on healthcare students and workers in Florence, Italy

ABSTRACTUniversal vaccination programmes against Hepatitis B Virus (HBV) have significantly reduced the burden of the disease; nevertheless, HBV infection remains a relevant issue for high-risk subjects, such as healthcare workers (HCWs), who may potentially be exposed to blood or body fluids. Our study evaluates the long-term duration of the immunological memory of HBV vaccination 11–23 years after primary immunization by examining the response to booster doses in HCWs and students of health disciplines at Careggi Teaching Hospital in Florence (Italy). All participants (n = 2,203) had received a complete HBV immunization course in infancy or adolescence. Blood samples were collected to measure antibody levels against the HBV surface antigen (anti-HBs); an anti-HBs titre <10 mIU/mL was considered as negative. The administration of the vaccination course during infancy induced lower long-term anti-HBs titres compared to those in case of vaccination performed during adolescence (titre <10 mIU/mL: 51.1% and 12.2% respectively; p < 0.001), also considering that an equal number of years has elapsed since vaccination. A booster dose administered to subjects vaccinated in infancy is able to induce anamnestic immunological response in a higher percentage of vaccinated people (p < 0.001). Few subjects (n. = 4) accepted a fifth dose of vaccine in the case of persistent anti-HBs negative titres; this aspect requires further investigation.The total absence of acute hepatitis B among vaccinated subjects suggests that the long incubation period of the disease allows the activation of immunologic memory mechanisms, which is also true in case of low anti-HBs level. In conclusion HCWs still represent a high-risk category; it is therefore, necessary to increase efforts to protect and vaccinate these subjects.

Alzheimer's Disease Progression: Factors Influencing Cognitive Decline.

Alzheimer's disease (AD) patients present high variability in the rate of cognitive decline. Despite the wide knowledge on factors influencing dementia risk, little is known on what accounts for AD progression. Previous studies on this topic have mainly analyzed each factor separately without taking into account the interaction between genetic and non-genetic factors. The aim of the present study is to evaluate the role of demographic, clinical, therapeutic, and genetic factors and their interaction on cognitive decline among newly diagnosed AD patients. We retrospectively selected 160 AD patients diagnosed at the Neurology Unit of Careggi University Hospital of Florence. We evaluated the occurrence of rapid cognitive changes defined as the worsening of more than four points at the Mini-Mental State Examination after 2-year follow up period. Among the 160 AD patients, 50% presented rapid disease progression. Extrapyramidal signs at disease onset were predictors of worse outcome (OR 2.2), especially among Apolipoprotein E (APOE) ɛ4 allele carriers, while the presence of family history for dementia decreased the risk of rapid progression by about 50%. Higher educated ɛ4-carriers showed a slower AD progression. We identified the chronic use of aspirin as potential secondary preventative strategy for the non ɛ4-carriers. At dementia onset, some clinical and demographic data can be predictors of future progression. The outcomes of the present study support the already hypothesized interaction between genetic and non-genetic factors during disease course and suggest genetic-based approaches.

Stereotactic vacuum-assisted breast biopsy: Comparison between 11- and 8-gauge needles

PurposeThe 11-gauge (11G) stereotactic vacuum-assisted breast biopsy (VABB) showed a better profile than 14G-VABB in terms of feasibility, safety, microcalcification sampling, and accuracy. Underestimation rates were significantly lower with 11G-VABB than with 14G-VABB. Thus, the introduction of an even larger needle at the VABB procedure could reduce this rate further. The purpose of this study was to compare the overall performance of stereotactic VABB with 8G and 11G needles. Materials and methodsFour hundred and three VABBs performed between July 2012 and February 2015 at the Breast Diagnostic Unit of Careggi Hospital in Florence were retrospectively analyzed; 197 were performed with 11G-VABB and 206 with 8G-VABB. Lesions were classified according to mammographical patterns in microcalcifications, architectural distortions, or opacities, and all biopsy targets were classified according to BIRADS classification as BIRADS III, IV or V. Data were collected on radiological classification of targets, imaging presentation, procedure time, number of specimens per procedure, and microcalcification retrieval on histological findings. Surgery was always performed when high-risk or malignant lesions (B3 or B5) were detected; the final diagnosis was made on surgical pathology. ResultsCompared to VABB with an 11G needle, 8G-VABB allows a reduction in the time needed to complete the procedure (20.6 versus 27.4, P < 0.00001) and the number of specimens collected per lesion (21.6 versus 12.2, P < 0.00001). Moreover, 8G-VABB resulted in the same diagnostic accuracy, and the underestimation rates were comparable between the two groups for both B3 and DCIS lesions. ConclusionsThe 8G needle should be considered as a valid alternative option in VABB for breast lesions.

Triage duration times: a prospective descriptive study in a level 1° emergency department

Triage is the most important tool for clinical risk management in emergency departments (ED). The timing measurement of its phases is fundamental to establish indicators and standards for the optimization of the system. To evaluate the duration time of the phases of triage; to evaluate some variables exerting influence on nurses' performance. prospective descriptive study performed in the ED of Careggi Teaching Hospital in Florence. 14 nurses enrolled by stratified randomization proportion (1/3 of the whole staff ), according to classes of length of service. Triage processes on 150 adult patients were recorded. The mean age of nurses was 39.7 years (SD ± 5.2, range 29-50); the average length of service was 10.3 years (SD ± 4.4, range 3-18); average of triage experience was 8.6 years (SD ± 4.3, range 2-13). The median time from patient's arrival to the end of the triage process was 04': 04" (range 00':47"- 18':08"); the median duration of triage was 01':11" (range 00':07" -11':27"). The length of service and triage experience did not influence the medians of recorded intervals of time, but there were some limitations due to the low sample size. Interruptions were observed 111 (74%) of triage cases. the recorded triage time intervals were similar to those reported in international literature. Actions are needed to reduce the impact of interruptions on triage process' times.

Addressing conflicting stakeholders’ priorities in surgical scheduling by goal programming

In this study, we propose a mixed integer multi-objective model which allows determining the number and typology of surgeries to be scheduled in each OR, day and session of a multiple day planning period, in context where each OR session of the planning horizon has already been assigned to a specialty, with the (multiple) objective of obtaining a desired: (i) patient due date fulfilment rate, (ii) OR utilisation, (iii) bed utilisation, (iv) number of scheduled surgeries. These objectives, reflect heterogeneous priorities of different stakeholders of the surgical scheduling process. To address the described multi-objective problem, we use a goal programming approach and we show how the exploration of the weight space, typical of such approach, can be more efficient if informed by a correlation analysis. The results presented in this study are based on real data from the Meyer University Children’s Hospital in Florence.

The Ways of Adjusting Hospitals For Children To The Needs of The Child – The Example of Meyer Children Hospital In Florence, Italy

Abstract Designing child hospitals is a complex, multi-layered process. Research shows, the patients’ environment has influence on the process of treatment. The feelings of isolation, powerlessness, discomfort and stress can be exacerbated by a inadequate design. Currently, many hospitals are built around the world, in which the design should help process of treatment. One of them is the Meyer Hospital in Florence, Italy, which is an excellent example of an interesting, functional and surprising hospital. The authors of the paper describe the urbanistic and architectural features as well as some elements of interior design, which have been adjusted to the perceptual and physical abilities of children. Some features of good design have also been distinguished, which can be applied also in the low-cost redecoration of the already existing hospitals. Thie aim of the article is to show a variety of possibilities in child hospital design. The article also shows that a hospital can be place which is attractive for patients, visitors, staff and even – owing to an interesting project – tourists.

Study of the Acceptance and Perceived Efficacy of Animal Assisted Therapy (AAT) for Parents and Nurses in the Psychiatry Unit of Meyer Children’s Hospital in Florence - Italy

Objectives: This short paper is part of wider research aimed at comparing the effects of Animal-Assisted Therapy (AAT) with a standard treatment protocol in 20 children and adolescents admitted to psychiatry hospitals for severe mental breakdown (with RCT). After analysing the global results we concluded that the benefits could not only be described in terms of direct effectiveness and care outcomes, but there were also other factors that we should consider, in particular in relation to the context of care. The focus was to analyze those factors, because the results of this treatment were quite distinctive and specific to AAT. The main purpose of this study was to examine the extent to which parents and nurses accept the effects of AAT and perceive its efficacy. Method: For this purpose, at the end of the AAT treatment, we gave a specially formulated questionnaire to both parents and nurses. Results: Data analyses showed that nurses evaluate AAT to be very efficient in improving both the adolescent's quality of stay in hospital and also their compliance with the care provided. Parents expressed a strong acceptance of AAT and evaluated this treatment as an efficient way to both improve the way in which their children express emotions and also facilitate their social skills. Conclusion: The study confirms, in a wider context, the results of our previous studies, not only on the clinical efficacy of AAT, but also on the perceived efficacy for parents and hospital staff and in the general context of care. This underlines the importance to further analyze the factors related to the environment and document the indirect benefits related to a more positive care environment.

Spedali Degli Innocenti, the Foundling Hospital in Florence, Italy

The author reflects on a visit to the Ospedale Degli Innocenti, the former Renaissance foundling hospital in Florence, having escaped from an international clinical conference. He considers the symbolism of...

Evaluating the impact of flexible practices on the master surgical scheduling process: an empirical analysis

This study focuses on the master surgical scheduling problem and adds two main contributions. First, it presents a novel mixed integer programming model to support the master surgical schedule production. Second, it uses the model to investigate the impact, in terms of scheduled surgeries, of the flexible management of three critical resources, namely surgical teams, operating rooms and surgical units. Our analysis revealed that to maximise the number of surgeries scheduled, it is sufficient to introduce flexibility with respect to surgical teams and ORs. In fact, if both these resources are managed flexibly, then introducing flexibility with respect to surgical units carries no additional advantages. However, if surgical teams or ORs (or both) are not managed flexibly, then managing surgical units flexibly produces significant benefits. In addition, our study shows that if surgical teams cannot be managed flexibly, then introducing flexibility with respect to ORs yields significant benefits. Similarly, it reveals that if ORs cannot be managed flexibly, then introducing flexibility with respect to surgical teams yields significant benefits as well. The work is based on real data from the Meyer University Children’s Hospital in Florence.

The Claims Management Committees trial: Experience of an Italian Hospital of the National Health System

Introduction: In Italy, health care is mainly financed by earmarked central and regional taxes, with regions receiving their allocated share of resources from the National Health Fund. The Council of the Tuscany Region in 2009 began an experimentation aimed to enforce the extrajudicial conciliation. The Council established the Claims Management Committees (CMC) for civil liability in the Tuscan Health Service. The CMC trial provides that the damages are compensated directly by the hospital, removing the cost of liability insurance. The aim of this study is to collect and compare the liability-insurance-period and the CMC trial-period. Materials and methods: Data were derived from the management claims database of the Health Directorate of the Careggi Hospital in Florence between 2006 and 2012. Two main periods are considered for the comparison of data: 2006–2007–2008 during the insurance management and 2010–2011–2012 during the CMC trial. Results: During the insurance management period, the total expenditure was equal to the €14,846,334.44 paid in the 3-year period. The total expenditure during the CMC trial 3-years period was equal to €7.076.370,75. Under the CMC management, we observed a marked decrease in the recourse to legal action in the face of a substantial maintenance of the number of claims opened for each year. The CMC trial showed a greater speed in setting claims for damages. Discussion and conclusions: Under CMC management, a greater and more diligent efficiency is matched by a lower economic outlay. The use of the direct management of damage compensation may be an important tool for risk management, thus guaranteeing the recourse to targeted and appropriate interventions.

Closed reduction of the isolated anterior frontal sinus fracture via percutaneous screw placement

Fractures of the frontal sinus are a common maxillofacial trauma and constitute 5–15% of all maxillofacial fractures. Conventional surgical approaches include the coronal flap, direct cutaneous incision, and endoscopic techniques. Minimally invasive techniques have recently been described for the reduction of the isolated anterior frontal sinus fracture via a closed approach. The medical records and radiological findings of all patients who underwent surgical treatment for anterior frontal sinus fractures from January 2009 to December 2013 at the study hospital in Florence, Italy, were reviewed. The final study sample consisted of 15 patients (13 males and two females) with isolated anterior frontal sinus fractures who were treated with closed reduction using percutaneous screws. The mean age was 32.1 years. The skin incisions healed without any visible scarring, and no depressions of the frontal sinuses were evident in the postoperative period. Computed tomography scans performed at 6 months postoperatively showed adequate reduction of the displaced fragments. This closed technique is a good option for displaced isolated fractures of the anterior frontal sinus. However, the technique is not adequate for complex fractures of the frontal sinus.

Comparing resource balancing criteria in master surgical scheduling: A combined optimisation-simulation approach

This study compares three different scheduling policies in the Master Surgical Scheduling context with respect to three performance criteria: efficiency, i.e. the capability of scheduling a large number of surgeries; balancing, i.e. the capability to distribute workload fairly among the resources involved in surgical activities; and robustness, i.e. the capability to prevent schedule disruptions caused by variability of surgical time and length of stay. We develop a mixed-integer programming model and compare three objective functions, each corresponding to a different scheduling policy. All the policies maximise the number of scheduled surgeries and balance the utilisation of post-surgical beds and operating rooms. However, they implement a different balancing criterion. To assess the robustness of the schedules produced by the optimisation model, we used a discrete event simulation model that samples surgical times and length of stay from a probability distribution and keeps track of schedule disruptions that may occur. The work is based on real data from the Meyer University Children׳s Hospital in Florence. It comprises an experimental campaign that extends to 27 hospital settings and uses both empirical and theoretical probability distributions. Overall, the study reveals that none of the investigated policies allows superior performance in terms of efficiency, balancing and robustness to be achieved concurrently. However, depending on the hospital management׳s priorities and needs, it is always possible to identify a policy that allows for a reasonable trade-off among these performance criteria. In addition, the study reveals the causal mechanisms that, under certain circumstances, make certain balancing criteria perform better than the others.

Inflammatory myofibroblastic tumor: Clinical, morphological, immunohistochemical and molecular features of a pediatric case

Inflammatory myofibroblastic tumor is an uncommon tumor regarded as “intermediate malignancy”. We present the clinical, pathological and molecular features of a mesenteric inflammatory myofibroblastic tumor in a 9-month-old male infant. The patient was referred to Anna Meyer Children Hospital of Florence, Italy, for an asymptomatic abdominal mass measuring about 7cm. The lesion was radically excised, and the postoperative course was uneventful. Histologically, the tumor was composed of spindle cells immunopositive for vimentin and desmin admixed with an inflammatory infiltrate. Rearrangement of ALK gene was demonstrated by FISH and immunohistochemistry (cytoplasmic, perinuclear and punctate immunocoloration). The peculiar punctate ALK immunocoloration suggested a possible unusual ALK gene rearrangement involving the CLTC gene.

Prognosis and health-related quality of life in elderly patients after a mild to moderate trauma

The aims of this study were to compare outcome after a mild to moderate trauma in three subgroups of patients of increasing age (A1: <50, A2: 50-74, A3: >74years) and to assess potential health-related quality of life (HRQOL) impairment. This is a follow-up study of a cohort of 418 trauma patients admitted to the High Dependency Unit of the Emergency Department of the University Hospital of Florence from July 2008 to February 2012. Six months after the event, a telephone interview using the Physical component summary (PCS) and Mental component summary (MCS) Health Composite Score (SF12) was conducted. Patients reported their QOL both at present and before trauma. In-hospital mortality was 10 of 418 (2.3%); overall mortality was 27 of 244 (11%) patients found at follow-up. No death was observed among A1 patients; overall mortality was (6/76) 7% in A2 and (21/71) 30% in A3 patients (p<0.05 A1 vs A2, A1 vs A3 and A2 vs A3). Before the event, respectively, 94 and 96% patients reported a normal MCS and PCS score (>39); after the event, the proportion of patients with a normal score value was significantly lower (MCS 70%, p=0.002; PCS 58%, p<0.0001). All subgroups showed a highly significant reduction in the scores' value due to the trauma. After the event, the proportion of patients with normal scores was significantly lower (all p<0.0001, except for MCS score in A1 subgroup, who showed p=0.013) within all subgroups. Elderly patients' prognosis was significantly worse compared with the younger counterpart; despite young patients' optimal outcome, HRQOL was uniformly reduced across all age groups.