Abstract
Purpose
The purpose of this study was to determine the outcome of “minor resuscitation” trauma
patients managed without the immediate presence of a surgeon.
Methods
In 2003, our hospital replaced surgeons with pediatric emergency medicine physicians
for level 2 (minor resuscitation) trauma alerts, whereas the level 1 (major resuscitation)
alerts remained surgeon directed. We compared patients treated in the 3 years before
(period 1) and after (period 2) this change. Patient records were analyzed for discharges,
alert upgrades, Injury Severity Score (ISS), time to destination, and mortality.
Results
There were 918 admissions and 93 discharges in period 1 compared with 815 admissions
and 652 discharges in period 2. In period 1, 3% were upgraded to level 1 status compared
with 9% in period 2 (P < .0001). The mean ISS of admitted patients and the percentage of critical (ISS >15)
patients were greater in period 2 (P < .001). The time to inpatient floor was longer in period 2, but the elapsed times
to operating room and to pediatric intensive care unit were not significantly different.
Conclusion
Pediatric emergency medicine physicians discharged more patients than the surgeons,
but also upgraded more to level 1 status. Level 2 trauma patients can be safely managed
without immediate surgeon presence.
Index words
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References
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- A leap in faith: the impact of removing the surgeon from the level II trauma response.J Pediatr Surg. 2006; 41: 693-699
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Article info
Footnotes
Papers presented at the 58th Annual Meeting of the Section on Surgery of the American Academy of Pediatrics.
Identification
Copyright
© 2007 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
