The management of severe trauma patients in the autonomous community of Valencia

Mínguez Platero J, García Bermejo P, Ruiz López JL, Millán Soria J

Background and aims: Traumatisms represent in our times the leading

cause of death during the first four decades of life. Without

belittling the importance of an effective prevention policy, there is a

need to guarantee the adequate management and therapy of these patients.

We review the current management of the critical patient and study

the possibilities of improvement whenever needed and wherever possible.

Methods: Multicenter study encompassing all the hospitals in the Valencia

Community. A closed-question survey questionnaire was prepared regarding

the attention to critical patients, which was mailed to the various

hospitalary Emergency Departments. Data acquisition and processing

was carried out using statistical models with assessment of the results.

Results: An admission registry for severe trauma cases is available in

61% of the Emergency Departments in the Valencia Community. The

greatest number of polytraumatism cases corresponds to traffic accidents

(40%). In 61% of the centres surveyed it is the Emergency Physician

who is responsible for the observation and evolutive control of the

cases. Among the Emergency Departments surveyed 33% did not have,

within their own sutructural unit, a capability for attending to multiple victims

at risk of death. As regards material and equipment availability,

23.8% of the hospital Emergency Departments did not have available,

at the time of the survey, a Philadelphia neck support. In 85% of the

surveyed Departments blood counts, blood biochemistries and coagulation

tests are routinely requested on admission, while only one-quarter

does request toxicologic tests per protocol (with a positivity rate of 25-

50%). X-ray examinations are protocolised in over 90% of the surveyed

Departments. As for the planification of training for the professionals in

the Emergency Departments, frequent training and/or update courses

are carried out in 15% of the centres, while 90% of all hospitalary centres

surveyed are accredited for docency by the Ministry of Health and

Consumer Affairs at the present time.

Conclusions: Even though the role of the hospital Emergency Departments

in the integrated plan for care to the polytraumatised patient is

evident, our study has detected an appreciable lack of coordination in

the hospital admission of the polytraumatised patient, with a lack of assistential

uniformity in the initial assessment and management when the various participating centres are compared.

García Bermejo P, Millán Soria J, Mínguez Platero J, Ruiz López JL