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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.

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