title: Intubation alone does not mandate trauma surgeon presence on patient arrival to the emergency department.
abstract: BACKGROUND
  Current American College of Surgeons Committee on Trauma criteria for major resuscitation include prehospital respiratory compromise or obstruction and/or intubation and mandate an attending trauma surgeon's presence on patient's arrival to the emergency department (ED). A substantial number of trauma patients arrive intubated, with no other physiologic compromise. We hypothesized that field or ED intubation in the absence of other major criteria does not require trauma surgeon presence on patient arrival.
  
  
  METHODS
  Data were collected from our trauma registry on all injured patients intubated in the field or on arrival to the ED over a 30-month period ending in June 2003. Patients meeting other American College of Surgeons Committee on Trauma criteria (systolic blood pressure < 90 mm Hg; gunshot wound to the neck, chest, or abdomen; and unstable patient transfers) were excluded.
  
  
  RESULTS
  During this period, 7,645 trauma patients were admitted to the ED; 834 were intubated, of whom 489 (59%) had no other criteria for major resuscitation. One was pronounced dead, 6 were admitted to the ward, 415 (85%) were admitted to the intensive care unit, and 67 (14%) were transferred directly to the operating room. Twenty-two (4%) required nonorthopedic or nonneurosurgical procedures, 11 (2%) of which were for hemorrhage control. Twelve of 16 stab wounds (75%) required emergent operation, 7 (44%) of which were for hemorrhage control. In contrast, 8 (3%) of 244 motor vehicle crashes required emergent operation, 4 (2%) of which were for hemorrhage control.
  
  
  CONCLUSIONS
  Intubated patients with central stab wounds represent a high-risk group and should mandate trauma surgeon presence on patient arrival. Excluding stab wounds, field or ED intubation alone rarely requires emergent surgical decision-making. Therefore, field or ED intubation alone should not mandate trauma surgeon presence on patient arrival.
authors.affiliation: Denver Health Medical Center and the University of Colorado Health Sciences Center, Denver, Colorado, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ciesla
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: John B
authors.initials: JB
authors.lastname: Moore
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Johnson
authors.forename: Clay C
authors.initials: CC
authors.lastname: Cothren
authors.forename: Jon M
authors.initials: JM
authors.lastname: Burch
mesh_terms: D000328:Adult; D003120:Colorado / Q000453:epidemiology; D003659:Decision Making, Organizational; D004630:Emergencies; D004632:Emergency Medical Services / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D015600:Glasgow Coma Scale; D006470:Hemorrhage / Q000209:etiology; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D009104:Multiple Trauma / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D020380:Needs Assessment / Q000458:organization & administration; D016134:Organizational Policy; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D014194:Traumatology / Q000458:organization & administration*