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The verification of the actual benefit of TC care is especially important in countries, like Italy, where the implementation of the modern principles of trauma care is still partial and the restrictions imposed on health-care expenditures may hinder the further diffusion of practices that are not supported by data. This study was conducted using data from the trauma registry of the region Emilia-Romagna (RRTG). Emilia-Romagna is an Italian region with about four and a half million inhabitants, a surface http://www.selleckchem.com/products/PLX-4720.html of twenty-two thousand square kilometres, and about eighty hospitals admitting acute patients. An organised Trauma System exists since 2006. This system is based on three hubs �C equivalent to level 1 TCs �C uniformly distributed across the territory. They receive patients from scene and other hospitals via a pre-hospital Emergency selleck chemicals Medical Service (EMS). The EMS is based on ground ambulances staffed with crews with variable medical skills and three anaesthetist-manned helicopters that operate only in daylight. There are no paediatric TCs. The RRTG collects data on a voluntary basis from the three TCs and from twelve other large hospitals with varied facilities. Its inclusion criteria are traumatic injuries with Injury Severity Score9 (ISS)?>?15 or admission to Intensive Care (ICU). Patients dead on arrival or early in the Emergency Room are recorded in a separate database, disregarded by the present study because they often lack important information such as anatomic injury severity. The RRTG collects information on demographics, injuries, pre-hospital and hospital clinical course and outcome, and comprises of more than one hundred data-points. The registry is managed by the Regional Health Agency. Individual RRTG data are linked via a regional personal identification code to other administrative data banks (e.g. hospital admissions, mortality) to complement the information. All the RRTG cases of the year 2007�C2011 were considered for inclusion. Patients whose main mechanism of injury were burns, asphyxia or drowning and those with age?Reelin are usual in studies involving trauma mortality prediction modelling because severity indexes may perform differently with these injuries (e.g. Ref. 10) and because the cut-offs of physiologic variables chosen for adults may not apply to infants. Between-hospital transferred patients were also excluded. Finally, we had to exclude all cases from one hospital because it has mixed characteristics. Although it was not originally designated as TC, its importance has grown over the years and it presently behaves as the referral centre of its catchment area for any kind of injured patients. Four covariates had missing values (maximum percentage of missing data 2.71%): Mechanism of injury, Systolic Blood Pressure, Glasgow Coma Scale motor, and Type of Prehospital rescue. We used multiple imputation11 to account for missing data. Five imputed data sets were created.