The rapid impact on mortality rates of a dedicated care team including trauma and emergency physicians at an academic medical center.
BACKGROUND
Trauma center designation can result in improved patient outcomes after injuries. Whereas the presence of trauma teams has been associated with improved trauma patient outcomes, the specific components, including the role of emergency medicine (EM)-trained, board-certified emergency physicians, have not been defined.


OBJECTIVE
To assess the outcomes of patients before and after the establishment of a dedicated trauma team that incorporated full-time EM-trained physicians with trauma specialists at a Level I trauma center at an academic institution.


METHODS
Secondary analysis of prospectively collected trauma registry data was performed to compare mortality rates of all treated trauma patients before and after this intervention.


RESULTS
The establishment of a dedicated specialty trauma team incorporating full-time EM presence including EM-trained, board-certified emergency physicians was associated with a reduction in overall non-DOA (dead on arrival) mortality rate from 6.0% to 4.1% from the time period preceding (1999-2000) to the time period after (2002-2003) this intervention (1.9% absolute reduction in mortality, 95% confidence interval [CI] 0.7%-3.0%). Among patients who were most severely injured (Injury Severity Score [ISS] ≥ 25), mortality rates decreased from 30.2% to 22.0% (8.3% absolute reduction in mortality, 95% CI 2.1%-14.4%). In comparison, there was minimal change in national mortality rates for patients with ISS ≥ 25 during the same time period (33% to 34%).


CONCLUSIONS
The implementation of a dedicated full-time trauma team incorporating both trauma surgeons and EM-trained, board-certified or -eligible emergency physicians was associated with improved mortality rates in trauma patients treated at a Level I academic medical center, including those patients presenting with the most severe injuries.
Gerardo
Charles J
CJ
Division of Emergency Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
Glickman
Seth W
SW
Vaslef
Steven N
SN
Chandra
Abhinav
A
Pietrobon
Ricardo
R
Cairns
Charles B
CB
D000046:Academic Medical Centers; D000328:Adult; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D011446:Prospective Studies; D012042:Registries; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*