title: Multiple, simultaneous trauma patients: Are they worse off?
abstract: BACKGROUND
  The simultaneous management of multiple severely injured patients has the potential to overwhelm trauma center resources. We hypothesize that trauma patients presenting in clusters of two or more patients within a short time period have worse outcomes.
  
  
  METHODS
  From the registry at our urban Level I trauma center, we reviewed 4,619 "major" trauma patients admitted during a span of 5.5 years (January 1998 through June 2003). A multidisciplinary team led by an in-house trauma surgery attending evaluated all patients. Pairs of two patients presenting less than 10 minutes apart (PAIRS) and clusters of three patients presenting within 30 minutes (CLUSTERS) were compared with patients arriving alone presenting over 4 hours apart (ALONE) and to other patients that did not meet any of the above criteria (OTHER). Multivariate regression was performed to determine differences in likelihood of direct operating room admissions, hospital, and intensive care unit (ICU) length of stay, and mortality.
  
  
  RESULTS
  PAIRS made up 8.9% (413) and CLUSTERS made up 2.7% (126) of patients; 42% (1,939) arrived ALONE; 48.3% (2,229) of patients were classified as OTHER. Multivariate regression showed no significant differences in ICU or hospital length of stay, or mortality for PAIRS or CLUSTERS compared with patients presenting ALONE. PAIR and CLUSTER patients were more likely to undergo immediate surgery than the ALONE group (odds ratio 1.37, 95% confidence interval 1.03-1.83 and 1.61, 95% CI 1.00-2.58, respectively).
  
  
  CONCLUSIONS
  When PAIRS or CLUSTERS of seriously injured patients arrive in close time proximity, they are more likely to be directly admitted to the operating room than patients arriving ALONE. This difference in management does not appear to affect patient outcomes.
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Shoher
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: David
authors.initials: D
authors.lastname: Efron
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D009104:Multiple Trauma / Q000628:therapy; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D012044:Regression Analysis; D014193:Trauma Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D014194:Traumatology / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014218:Triage; D016526:Workload