How health service delivery guides the allocation of major trauma patients in the intensive care units of the inclusive (hub and spoke) trauma system of the Emilia Romagna Region (Italy). A cross-sectional study.

Objective: To evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system.

Setting: ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million.

Regional variation in hospitalisation and mortality in heart failure: comparison of England and Lombardy using multistate modelling.

Heart failure (HF) is a common, serious chronic condition with high morbidity, hospitalisation and mortality. The healthcare systems of England and the northern Italian region of Lombardy share important similarities and have comprehensive hospital administrative databases linked to the death register. We used them to compare admission for HF and mortality for patients between 2006 and 2012 (n = 37,185 for Lombardy, 234,719 for England) with multistate models.

A population based study on the night-time effect in trauma care.

Background: The so-called off hour effect-that is, increased mortality for patients admitted outside normal working hours-has never been demonstrated in trauma care. However, most of the studies excluded transferred cases. Because these patients are a special challenge for trauma systems, we hypothesised that their processes of care could be more sensitive to the off hour effect.

Clinical governance network for clinical audit to improve quality in epithelial ovarian cancer management.

Background: Epithelial ovarian cancer (EOC) is the most lethal gynecological cancer. Several hospitals throughout the region provide primary treatment for these patients and it is well know that treatment quality is correlated to the hospital that delivers. The aim of this study was to investigate the management and treatment of EOC in a Region of the North Italy (Emilia-Romagna, Italy).

Evaluation of the survival benefit of Trauma-Centre care in the Italian setting.

Background: Trauma Centres (TC) are expected to have a lower mortality - after controlling for injury-severity - than non-designated hospitals in order to justify their funding. This benefit has been demonstrated in the USA not long ago, while the evidence from other settings is still limited. We evaluated the mortality benefit of TC care in an Italian setting, where the first Trauma System with designated TCs was instituted six years ago.

Is the TMPM-ICD9 revolution in trauma risk-adjustment compatible with imperfect administrative coding?

Background: TMPM-ICD9 is the latest injury-severity measure based on empirical estimation from ICD-9-CM codes. It is candidate to replace expert-based AIS measures worldwide because of easier accessibility and better predictive performances. In Italy and other countries administrative ICD coding is generally less complete than dedicated AIS coding.

The counterintuitive effect of multiple injuries in severity scoring: a simple variable improves the predictive ability of NISS.

Background: Injury scoring is important to formulate prognoses for trauma patients. Although scores based on empirical estimation allow for better prediction, those based on expert consensus, e.g.