The impact of managing moderately injured pediatric trauma patients without immediate surgeon presence



      The purpose of this study was to determine the outcome of “minor resuscitation” trauma patients managed without the immediate presence of a surgeon.


      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.


      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.


      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Helling T.S.
        • Nelson P.W.
        • Shook J.W.
        • et al.
        The presence of in-house attending trauma surgeons does not improve management or outcome of critically injured patients.
        J Trauma. 2003; 55: 20-25
        • Nwomeh B.C.
        • Georges A.J.
        • Groner J.I.
        • et al.
        A leap in faith: the impact of removing the surgeon from the level II trauma response.
        J Pediatr Surg. 2006; 41: 693-699
        • Hutter M.M.
        • Kellogg K.C.
        • Ferguson C.M.
        • et al.
        The impact of the 80-hour resident workweek on surgical residents and attending surgeons.
        Ann Surg. 2006; 243: 864-871
        • Nuss K.E.
        • Dietrich A.M.
        • Smith G.A.
        Effectiveness of a pediatric trauma team protocol.
        Pediatr Emerg Care. 2001; 17: 96-100
        • Ziegler M.M.
        Pediatric surgical training: an historic perspective, a formula for change.
        J Pediatr Surg. 2004; 39: 1159-1172
        • Sherman H.F.
        • Landry V.L.
        • Jones L.M.
        Should level I trauma centers be rated NC-17?.
        J Trauma. 2001; 50: 784-791
        • Hayes J.R.
        • Groner J.I.
        Re: “Should Level I trauma centers be rated NC-17”?.
        J Trauma. 2002; 52: 189-190
        • Rogers F.B.
        • Simons R.
        • Hoyt D.B.
        • et al.
        In-house board-certified surgeons improve outcome for severely injured patients: a comparison of two university centers.
        J Trauma. 1993; 34: 871-875