title: Influence of resident involvement on trauma care outcomes.
abstract: OBJECTIVE
  Discrepancies exist in complications and outcomes at teaching trauma centers (TTCs) vs nonteaching TCs (NTCs).
  
  
  METHODS
  Retrospective review of the National Trauma Data Bank research data sets (January 1, 2007, through December 31, 2008).
  
  
  METHODS
  Level II TCs.
  
  
  METHODS
  Patients at TTCs were compared with patients at NTCs using demographic, clinical, and outcome data. Regression modeling was used to adjust for confounding factors to determine the effect of house staff presence on failure to rescue, defined as mortality after an in-house complication.
  
  
  METHODS
  The primary outcome measures were major complications, in-hospital mortality, and failure to rescue.
  
  
  RESULTS
  In total, 162 687 patients were available for analysis, 36 713 of whom (22.6%) were admitted to NTCs. Compared with patients admitted to TTCs, patients admitted to NTCs were older (52.8 vs 50.7 years), had more severe head injuries (8.3% vs 7.8%), and were more likely to undergo immediate operation (15.0% vs 13.2%) or ICU admission (28.1% vs 22.8%) (P < .01 for all). The mean Injury Severity Scores were similar between the groups (10.1 for patients admitted to NTCs vs 10.4 for patients admitted to TTCs, P < .01). Compared with patients admitted to TTCs, patients admitted to NTCs experienced fewer complications (adjusted odds ratio [aOR], 0.63; P < .01), had a lower adjusted mortality rate (aOR, 0.87; P = .01), and were less likely to experience failure to rescue (aOR, 0.81; P = .01).
  
  
  CONCLUSIONS
  Admission to level II TTCs is associated with an increased risk for major complications and a higher rate of failure to rescue compared with admission to level II NTCs. Further investigation of the differences in care provided by level II TTCs vs NTCs may identify areas for improvement in residency training and processes of care.
authors.affiliation: Division of Trauma and Critical Care, Department of Surgery, Cedars-Sinai Medical Center, 8635WThird St, Ste 650, Los Angeles, CA 90048, USA. marko.bukur@cshs.org
authors.forename: Marko
authors.initials: M
authors.lastname: Bukur
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Singer
authors.forename: Rex
authors.initials: R
authors.lastname: Chung
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Ley
authors.forename: Darren J
authors.initials: DJ
authors.lastname: Malinoski
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Margulies
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
mesh_terms: D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014193:Trauma Centers; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000601:surgery*