Relevance of trauma team organization in the management of severe injuries: the Niguarda model in Milan

A major trauma is not merely an accident but a disease needing a continuity of care for patients involved. The extension of injuries is often unpredictable and hence patients need a trauma service composed of many specialists constantly available 24 h round. This study was undertaken to analyze comprehensive strategy and outcomes of Niguarda Trauma Team System in the management of severe trauma over a 6-year experience (October 2002–December 2008). The data of 2,256 consecutive patients’ classified red or yellow code were derived from the database of Niguarda Trauma Registry and analyzed according to severity scores: Abbreviated Injury Score (AIS), Injury Severity Score (ISS), Revised Trauma Score (RTS) and Probability of Survival (Ps). Missing the diagnosis of major trauma (ISS ≥ 16) was regarded as an undertriage, while treating patients with minor trauma (ISS 0.25) in patients with AIS ≤ 5. Patients who died showed a progressively increased ISS outlining a more severe patterns of injuries in deceased patients. The adoption of a comprehensive strategy in the management of severe trauma proved a beneficial impact on outcomes and mortality rates.