A leap in faith: the impact of removing the surgeon from the level II trauma response.
BACKGROUND
Limitation of resident work hours has created the need to explore alternatives to surgeon presence during initial assessment and resuscitation for selected life-threatening injuries in children. We recently eliminated the requirement for surgeon presence during Level II alerts. The purpose of this study was to evaluate the impact of this change on patient care.


METHODS
A retrospective analysis of trauma alert activity was performed using data from our trauma registry. In March 2003, responsibility for level II alerts was transferred from the pediatric surgeons (PSs) to the Emergency Department (ED) physicians. We compared the activity in the 18-month period before this change (period 1; n = 627) to that afterward (period 2; n = 587). Outcome measures included injury severity score, emergency department length of stay, missed injuries, abdominal computed tomography use, and mortality. Data were analyzed using log-rank statistic, chi2, or t test, where appropriate, with significance level at P < .05.


RESULTS
During the entire study period, 1499 patients met the trauma alert activation criteria of which 1214 (81%) were level II alerts. The mean injury severity score for period 1 (8.5 +/- 7.3 SD) was similar to period 2 (9.0 +/- 7.1 SD). When ED physicians replaced PS for Level II alerts, ED length of stay increased from 135 minutes to 165 minutes (P < .001). In addition, the use of abdominal computed tomography was significantly decreased (53.6% vs 42.6%; P < .001). However, there were no missed injuries and no significant differences in the rate of mortality.


CONCLUSIONS
When ED physicians replaced PS for Level II alerts, trauma room length of stay was increased, but use of abdominal imaging was decreased with no differences in rate of missed injury or mortality. Emergency Department physicians can safely replace PS during Level II alerts. These findings may be useful to institutions experiencing surgical workforce limitations for trauma alerts.
Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine and Public Health, Children's Hospital, Columbus, OH 43205, USA. nwomehbe@chi.osu.edu
Benedict C
BC
Nwomeh
Anthony J
AJ
Georges
Jonathan I
JI
Groner
Kathy J
KJ
Haley
John R
JR
Hayes
Donna A
DA
Caniano
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000145:classification*; D005260:Female; D013502:General Surgery; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D000078329:Workforce; D014947:Wounds and Injuries / Q000601:surgery*