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

Abstract

ObjectiveTo evaluate cross-sectional patient distribution and standardised 30-day mortality in the intensive care units (ICU) of an inclusive hub and spoke trauma system.SettingICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5 million.Participants5300 patients with an Injury Severity Score (ISS) >15 were admitted to the regional ICUs and recorded in the Regional Severe Trauma Registry between 2007 and 2012. Patients were classified by the Abbreviated Injury Score as follows: (1) traumatic brain injury (2) multiple injuriesand (3) extracranial lesions. The SIATs were divided into those with at least one neurosurgical level II trauma centre (TC) and those with a neurosurgical unit in the level I TC only.ResultsA higher proportion of patients (out of all SIAT patients) were admitted to the level I TC at the head of the SIAT with no additional neurosurgical facilities (1083/1472, 73.6%) compared with the level I TCs heading SIATs with neurosurgical level II TCs (1905/3815; 49.9%). A similar percentage of patients were admitted to level I TCs (1905/3815; 49.9%) and neurosurgical level II TCs (1702/3815, 44.6%) in the SIATs with neurosurgical level II TCs. Observed versus expected mortality (OE) was not statistically different among the three types of centre with a neurosurgical unit; however, the best mean OE values were observed in the level I TC in the SIAT with no neurosurgical unit.ConclusionThe Hub and Spoke concept was fully applied in the SIAT in which neurosurgical facilities were available in the level I TC only. The performance of this system suggests that competition among level I and level II TCs in the same Trauma System reduces performance in both. The density of neurosurgical centres must be considered by public health system governors before implementing trauma systems.

Editorial. Neurosurgery in the storm of COVID-19: suggestions from the Lombardy region, Italy (ex malo bonum)

“…According to such estimated caseloads, a plan of action was settled on clustering all urgent neurosurgical activities (mainly trauma and vascular) among only 3 centers (Niguarda, Brescia, and Varese), which were chosen based on geographical criteria as well as their receptive capacity, creating a hub-and-spoke scheme. 2 Only one other hospital for the entire region (Fondazione IRCCS Istituto Neurologico Besta) was identified to deal with nondeferrable tumor cases.…”

Innovation technology in neurorehabilitation: introducing a hub and spoke model to avoid patient “migration” in Sicily

“…The HSM has been mainly applied to manage the acute phase of neurological diseases (Demaerschalk, 2013; Chieregato et al , 2017; Gadhia, 2018). In particular, it has been demonstrated that an innovative HSM using a telestroke network may increase the number of patients discharged home and reduce the costs borne by the network hospitals (Demaerschalk et al , 2013; and 2018)…”

Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury

“…Nonetheless, a recent Italian study reported that about 12% of all severe TBI patients were admitted to the nearest hospital without neurosurgery capabilities (no-NSH) [ 16 ].…”