This is a common result in many epidemiologic studies. Ciesla et al. [21] observed that access to a designated trauma centre was dependent on proximity for severely injured elderly, while distance from trauma centre did not limit admissions for children and adults. Hsia et al. [22] demonstrated that the odds of admission to a trauma centre decreased with increasing age. In Lombardia Selleck Tofacitinib the percentage of hospital deaths has been higher in non level one or two hospitals: the lack of local expertise, reduced technology as well as unavailability of specialists are recognized causes of increased trauma mortality. At the time of the study a regionalized trauma system did not exist, triage

protocols for centralization of severely injured were not uniformly applied and a formal hospital trauma team organization was active only in one hospital of the region. Moreover, severely injured older than 64 were the 46% of study population, with the highest hospital death rate (from 25% to 46%). All these considerations may explain why the mortality presented in this Italian study is higher than other reports [23]. During the late 2012 a new law has formally Selleckchem PU-H71 instituted in Lombardia the regional trauma system. Now, efforts are needed to determine trauma ARN-509 molecular weight resources

and triage protocols and this study may be helpful to this project. A special consideration is due to the severe trauma in the elderly, in terms of amount of resources expended with regard to the level of functional recovery. Recently, Grossman et al. [24] demonstrated an appreciable acute survival (66% or 69%, with or without brain injury) for geriatric trauma patients (>64) admitted to a level one trauma centre with an Amine dehydrogenase ISS > 29. Moreover, a good long term recovery has been observed in 67%. The prolonged life expectancy and active life style of many elderly, the increasing number of severe trauma

after 64 years, together with promising results of modern trauma care, suggest the use of significant resources also in geriatric trauma, although with specific protocols to avoid futility. Causes of trauma Evaluating the causes of trauma, a precise definition in our study has been possible only in half of cases: in 21.27% the datum has been missed (i.e. not indicated on hospital report) while in 30% the category “other mechanism” has been assigned. Nevertheless, it is possible to make some observation in more than five thousands of cases for whom cause of trauma was precise and available. Young-adult males have been more exposed to road related accidents, while females in old age have been principally victims of unintentional domestic injuries. These results are consistent with other epidemiologic surveys [25–27]. Moreover, the age of injured females has been higher for all causes of injury and the same has been also observed in fatal trauma.