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In-House Attending Trauma Surgeon Does Not Reduce Mortality in Patients Presented to a Level 1 Trauma Center

Published online by Cambridge University Press:  26 April 2022

Nadia AG Hakkenbrak Open the ORCID record for Nadia AG Hakkenbrak [Opens in a new window] ,
Sarah Mikdad ,
Daphne van Embden ,
Georgios F. Giannakopoulos ,
Frank W. Bloemers ,
Tim Schepers  and
Jens A. Halm
Nadia AG Hakkenbrak*
Affiliation:
Department of Trauma Surgery, Amsterdam University Medical Center, Location VUMC and AMC, Amsterdam, the Netherlands Department of Trauma Surgery, Northwest Clinics, Alkmaar, the Netherlands
Sarah Mikdad
Affiliation:
Department of Trauma Surgery, Amsterdam University Medical Center, Location VUMC and AMC, Amsterdam, the Netherlands
Daphne van Embden
Affiliation:
Department of Trauma Surgery, Amsterdam University Medical Center, Location VUMC and AMC, Amsterdam, the Netherlands
Georgios F. Giannakopoulos
Affiliation:
Department of Trauma Surgery, Amsterdam University Medical Center, Location VUMC and AMC, Amsterdam, the Netherlands
Frank W. Bloemers
Affiliation:
Department of Trauma Surgery, Amsterdam University Medical Center, Location VUMC and AMC, Amsterdam, the Netherlands
Tim Schepers
Affiliation:
Department of Trauma Surgery, Amsterdam University Medical Center, Location VUMC and AMC, Amsterdam, the Netherlands
Jens A. Halm
Affiliation:
Department of Trauma Surgery, Amsterdam University Medical Center, Location VUMC and AMC, Amsterdam, the Netherlands
*
Correspondence: N.A.G. Hakkenbrak, Amsterdam UMC, Location VUMC, Department of Trauma Surgery, Room 7F-002, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands, E-mail: n.hakkenbrak@amsterdamumc.nl
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Abstract

Background:

Trauma is the leading cause of death in the Western world. Trauma systems have been paramount in opposing this problem. Commonly, Level 1 Trauma Centers are staffed by in-house (IH) attending trauma surgeons available 24/7, whereas other institutions function on an on-call (OC) basis with defined response times. There is on-going debate about the value of an IH attending trauma surgeon compared to OC trauma surgeons regarding clinical outcome.

Methods:

This study was performed at a tertiary care facility complying with all requirements to be a designated Level 1 Trauma Center as defined by the American College of Surgeons Committee on Trauma (ACSCOT). Inclusion occurred from January 1, 2012 through December 31, 2013. Patients were assigned an identifier for IH trauma surgeon attendance versus OC attendance. The primary outcome variable studied was overall mortality in relation to IH or OC attending trauma surgeons. Additionally, time to operating theater, hospital length-of-stay (HLOS), and intensive care unit (ICU) admittance were investigated.

Results:

A total of 1,287 unique trauma cases in 1,285 patients were presented to the trauma team. Of all cases, 712 (55.3%) occurred between 1700h and 0800h. These 712 cases were treated by an IH attending in 66.3% (n = 472) and an OC attending in 33.7% (n = 240). In the group of patients treated by an IH attending trauma surgeon, the overall mortality rate was 5.5% (n = 26); in the group treated by an OC attending, the overall mortality rate was 4.6% (n = 11; P = .599). Cause of death was traumatic brain injury (TBI) in 57.6%. No significant difference was found in the time between initial presentation at the trauma room and arrival in the operating theater.

Conclusion:

In terms of trauma-related mortality during non-office hours, no benefit was demonstrated through IH trauma surgeons compared to OC trauma surgeons.

Keywords

in-house attendancemortalitynon-office hourspreventable deathtrauma surgeon
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 37 , Issue 3 , June 2022 , pp. 373 - 377
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

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Footnotes

Note: Authors Hakkenbrak and Mikdad made equal contribution to this manuscript.

References

Data 2017, WISQARS. National Center for Health Statistics (NCHS), National Vital Statistics System. Hyattsville, Maryland USA: NCHS; 2017.Google Scholar
Celso, B, Tepas, J, Langland-Orban, B, et al. A systematic review and meta-analysis comparing outcome of severely injured patients treated in trauma centers following the establishment of trauma systems. J Trauma. 2006;60(2):371–378.CrossRefGoogle ScholarPubMed
Demetriades, D, Martin, M, Salim, A, Rhee, P, Brown, C, Chan, L. The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg. 2005;242(4):512–517.CrossRefGoogle ScholarPubMed
MacKenzie, EJ, Rivara, FP, Jurkovich, GJ, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl J Med. 2006;354(4):366–378.CrossRefGoogle ScholarPubMed
Durham, R, Shapiro, D, Flint, L. In-house trauma attendings: is there a difference? Am J Surg. 2005;190(6):960–966.10.1016/j.amjsurg.2005.08.028CrossRefGoogle ScholarPubMed
Maier, RV, Jurkovich, GJ. Debate regarding the necessity and benefits of attending surgeon in-house call for the care of acutely injured patients. J Trauma. 1993;34(6):915–916.CrossRefGoogle ScholarPubMed
Porter, JM, Ursic, C. Trauma attending in the resuscitation room: does it affect outcome? Am Surg. 2001;67(7):611–614.Google ScholarPubMed
Cox, JA, Bernard, AC, Bottiggi, AJ, et al. Influence of in-house attending presence on trauma outcomes and hospital efficiency. J Am Coll Surg. 2014;218(4):734–738.CrossRefGoogle ScholarPubMed
van der Vliet, QMJ, van Maarseveen, OEC, Smeeing, DPJ, et al. Severely injured patients benefit from in-house attending trauma surgeons. Injury. 2019;50(1):20–26.CrossRefGoogle ScholarPubMed
Claridge, JA, Carter, JW, McCoy, AM, Malangoni, MA. In-house direct supervision by an attending is associated with differences in the care of patients with a blunt splenic injury. Surgery. 2011;150(4):718–726.CrossRefGoogle ScholarPubMed
Khetarpal, S, Steinbrunn, BS, McGonigal, MD, et al. Trauma faculty and trauma team activation: impact on trauma system function and patient outcome. J Trauma. 1999;47(3):576–581.CrossRefGoogle ScholarPubMed
Luchette, F, Kelly, B, Davis, K, et al. Impact of the in-house trauma surgeon on initial patient care, outcome, and cost. J Trauma. 1997;42(3):490–495.CrossRefGoogle Scholar
Demarest, GB, Scannell, G, Sanchez, K, et al. In-house versus on-call attending trauma surgeons at comparable Level I trauma centers: a prospective study. J Trauma. 1999;46(4):535–540.CrossRefGoogle ScholarPubMed
Helling, TS, Nelson, PW, Shook, JW, Lainhart, K, Kintigh, D. The presence of in-house attending trauma surgeons does not improve management or outcome of critically injured patients. J Trauma. 2003;55(1):20–25.10.1097/01.TA.0000071621.39088.7BCrossRefGoogle ScholarPubMed
Havermans, RJM, de Jongh, MAC, Bemelman, M, van Driel, APG, Noordergraaf, GJ, Lansink, KWW. Trauma care before and after optimization in a Level I trauma center: life-saving changes. Injury. 2019;50(10):1678–1683.CrossRefGoogle Scholar
American College of Surgeons Committee on Trauma. Resources for the Optimal Care of the Injured Patient. Chicago, Illinois USA: American College of Surgeons; 2014.Google Scholar
Frellesen, C, Boettcher, M, Wichmann, JL, et al. Evaluation of a dual-room sliding gantry CT concept for workflow optimization in polytrauma and regular in- and outpatient management. Eur J Radiol. 2015;84(1):117–122.CrossRefGoogle Scholar
Fung Kon Jin, PH, Goslings, JC, Ponsen, KJ, van Kuijk, C, Hoogerwerf, N, Luitse, JS. Assessment of a new trauma workflow concept implementing a sliding CT scanner in the trauma room: the effect on workup times. J Trauma. 2008;64(5):1320–1326.Google ScholarPubMed
Henry, SM. ATLS Advanced Trauma Life Support Student Course Manual. 10th ed. Chicago, Illinois USA: ACS American College of Surgeons; 2018.Google Scholar
Eastes, LS, Norton, R, Brand, D, Pearson, S, Mullins, RJ. Outcomes of patients using a tiered trauma response protocol. J Trauma. 2001;50(5):908–913.10.1097/00005373-200105000-00022CrossRefGoogle ScholarPubMed
Ochsner, MG, Schmidt, JA, Rozycki, GS, Champion, HR. The evaluation of a two-tier trauma response system at a major trauma center: is it cost effective and safe? J Trauma. 1995;39(5):971–977.CrossRefGoogle Scholar
Plaisier, BR, Meldon, SW, Super, DM, et al. Effectiveness of a 2-specialty, 2-tiered triage and trauma team activation protocol. Ann Emerg Med. 1998;32(4):436–441.CrossRefGoogle ScholarPubMed
Terregino, CA, Reid, JC, Marburger, RK, Leipold, CG, Ross, SE. Secondary emergency department triage (super-triage) and trauma team activation: effects on resource utilization and patient care. J Trauma. 1997;43(1):61–64.CrossRefGoogle Scholar
Harmsen, AMK, Giannakopoulos, GF, Terra, M, de Lange de Klerk, ESM, Bloemers, FW. Ten-year maturation period in a Level-I trauma center, a cohort comparison study. Eur J Trauma Emerg Surg. 2017;43(5):685–690.CrossRefGoogle Scholar
Goslings, JC, Ponsen, KJ, Luitse, JS, Jurkovich, GJ. Trauma surgery in the era of nonoperative management: the Dutch model. J Trauma. 2006;61(1):111–114.CrossRefGoogle ScholarPubMed
Saltzherr, TP, Wendt, KW, Nieboer, P, et al. Preventability of trauma deaths in a Dutch Level-1 trauma center. Injury. 2011;42(9):870–873.10.1016/j.injury.2010.04.007CrossRefGoogle Scholar
Rikken, QG, Chadid, A, Peters, J, Geeraedts, LM, Giannakopoulos, GF, Tan, EC. Epidemiology of penetrating injury in an urban versus rural level 1 trauma center in the Netherlands. Hong Kong Journal of Emergency Medicine. 2020.Google Scholar