Emergent management of multisystem injuries by a general trauma surgeon.
OBJECTIVE
To determine the requisite education and scope of practice for a general surgeon trained to deliver emergent trauma care without the need for specialty consultation.


METHODS
Retrospective case review.


METHODS
Private Level I trauma center.


METHODS
4097 trauma patients admitted between 1/1/92 and 30/6/97.


METHODS
Mechanisms of injury; operations (total within the first 24 h) by mechanism and by surgical specialty.


RESULTS
Of 4097 trauma patients, 1086 (27%) underwent 1772 operative procedures within 24 h of admission, and 246 (6%) underwent 484 later operations. Orthopaedic and general surgical procedures were most common (51% of early operations). Early operations were most commonly orthopaedic for blunt trauma and general surgical for penetrating trauma. Although 685 patients (16.7%) received neurosurgical evaluation, only 150 early operations were performed (8% of the total early operations). At least 1244 procedures (55%) fell within the scope of current trauma general surgical practice advocated by some authorities.


CONCLUSIONS
The contribution of the various specialties to early operative trauma management is a function of the injury mechanism. As orthopaedics and neurosurgery together comprise 34% of emergency practice, a fully credentialed general surgeon with additional training in these disciplines could perform up to 90% of early operations.
Margulies
D R
DR
Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. margulies@surgery.csmc.edu
Cohen
M
M
Hiatt
J R
JR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D010819:Physician's Role; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods*; D014193:Trauma Centers