{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T03:00:51Z","timestamp":1791255651516,"version":"4.1.0"},"reference-count":32,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,7,20]]},"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>ICUs of the Integrated System for Trauma Patient Care (SIAT) of Emilia-Romagna, an Italian region with a population of approximately 4.5\u2009million.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>5300 patients with an Injury Severity Score (ISS) &gt;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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-016415","type":"journal-article","created":{"date-parts":[[2017,9,30]],"date-time":"2017-09-30T20:10:19Z","timestamp":1506802219000},"page":"e016415","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["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"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6690-8597","authenticated-orcid":false,"given":"Arturo","family":"Chieregato","sequence":"first","affiliation":[{"name":"Neurorianimazione, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa","family":"Volpi","sequence":"additional","affiliation":[{"name":"1a Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Gordini","sequence":"additional","affiliation":[{"name":"Rianimazione ed Emergenza Territoriale 118, Ospedale Maggiore, AUSL Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Ventura","sequence":"additional","affiliation":[{"name":"Servizio Strutture, Tecnologie e Sistemi Informativi, Direzione Generale Cura della persona, Salute, Welfare - Assessorato alla Sanit\u00e0 - Regione Emilia-Romagna, Bologna, Italy"},{"name":"Area Governo Clinico, Agenzia Sanitaria e Sociale - Regione Emilia Romagna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Barozzi","sequence":"additional","affiliation":[{"name":"Pronto Soccorso e Coordinamento emergenze traumatologiche, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Luisa Rita","family":"Caspani","sequence":"additional","affiliation":[{"name":"1a Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Fabbri","sequence":"additional","affiliation":[{"name":"Pronto Soccorso e Medicina d \u2019Urgenza, Ospedale di Forl\u00ec, Azienda AUSL di Romagna, Forl\u00ec, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Maria","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Pronto Soccorso e Medicina d\u2019Urgenza, Azienda Ospedaliera Arcispedale Santa Maria Nuova\u2013IRCCS, Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Ferri","sequence":"additional","affiliation":[{"name":"Rianimazione ed Emergenza Territoriale 118, Ospedale Maggiore, AUSL Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimone","family":"Giugni","sequence":"additional","affiliation":[{"name":"Rianimazione ed Emergenza Territoriale 118, Ospedale Maggiore, AUSL Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Marino","sequence":"additional","affiliation":[{"name":"Governo Clinico - 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