We must analyse every single case of death and Trauma Registry is the first tool to evaluate trauma care in a modern EMS.The emergency entrance of a hospital in Philadelphia in 2019. Scores are very practical and useful but they aren't enough. Quality audit can't consider only RTS, ISS and TRISS. The high number of ATLS providers in the trauma team could be one of causes of good results. This result is better than other hospitals in Milan. The 4% of overall mortality rate is similar to Trauma Centers in USA. Diagnostic and therapeutic protocols are similar to countries where a Trauma Center is active. Penetrating injury are very rare, 5% of incidence. Our data are typical of an urban area of a western country. His clinical RTS in the emergency room was 12 (7,4808 in the statistical analysis) and no severe lesions were observed during primary and secondary survey. Only for 1 patient it was impossibile to determine the cause of death so he was considered a potentially preventable death. The main cause of death was the cerebral injury. In 2 cases the cause of death was established by clinical examination and in 1 case police are still investigating for poisons or other letal drugs. One patient died in surgical ward), 1 at Ospedale Niguarda. 12 patients died (mortality rate 4.08%), 11 at Policlinico (2 in the emergency room, 3 in the operative room, 5 in ICU. Total length of staying was 8.9 +/- 11.2 (mean +/- SD) days (median of 5.5 days) and the length of ICU was (mean +/- SD) 11.7 +/- 10.3 days (median 9 days). Forty five patients (15%) required a surgical treatment during the first 48 hours. A penetrating injury was observed only in 5% of cases. Motorvehicle and road incident were the main cause of trauma (55.5%). We selected 299 patients, 207 males and 92 females. We collected the autopsy of the all death patients. Patients were followed during their staying at the hospital to record length of staying, lenght of ICU and mortality rate. We selected patients admitted among 6917 trauma patients observed in this period. We collected demographic data, informations about the traumatic event and prehospital rescue, emergency room examination, diagnostic exams, surgical operations and results of treatment. We have observed trauma patients admitted to Ospedale Maggiore from January to December 2004. To analyse major trauma patients admitted to Ospedale Maggiore Policlinico IRCCS to evaluate diagnostic and therapeutic protocols in order to identify preventable deaths. Creating a Trauma Registry is the prerogative to analyse the quality of assistance and to propose new solutions. There isn't an official registry for trauma. In Mila (Italy)o Emergency Medical System is organized by Regional rules and five Hospitals warrant high level of care for trauma patients. Many attempts have been done to increase the quality of trauma care in prehospital and hospital phases, but only by local resources. In Italy there isn't a State Trauma System.
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