Standardized handover improves trauma team communication: evidence from a level I Trauma Center in Italy

Effective communication during trauma handover is critical to ensuring continuity and quality of care. The ATMIST framework offers a standardized format for transferring essential patient information between pre-hospital and hospital teams. To quantify the concordance between information transmitted by emergency medical services (EMS) and data documented during in-hospital trauma handovers using the ATMIST protocol at a Level I Trauma Center in Italy. We conducted a prospective observational study of trauma patients admitted between December 2023 and May 2024. Variables analyzed included demographics, mechanism of injury, vital signs, suspected injuries, and pre-hospital interventions. Concordance was defined as the presence of matching information in both pre-hospital and in-hospital records. We calculated absolute agreement percentages and unweighted Cohen's kappa coefficients to assess inter-observer agreement. Of 118 trauma patients evaluated, 85 met inclusion criteria. The overall mean absolute agreement across all variables was 74.5% (± 12.7). The highest concordance was observed for endotracheal intubation (95.5%, κ = 0.87) and patient age (94.3%, κ = 0.68). The lowest agreement was found for time of injury (κ = 0.10) and triage priority (κ = 0.12), indicating substantial variability in the transmission of time-sensitive and prioritization data. Structured handover using the ATMIST framework reliability conveyed critical clinical interventions and core patient characteristics. However, logistical and prioritization elements showed poor concordance, representing key targets for system improvement. Standardized training and the integration of digital handover tools may further enhance communication accuracy and patient safety.