title: Addition of a general surgeon without addition of appropriate support is inadequate to improve outcomes of trauma patients in a rural setting: a cohort study of 1962 consecutive patients.
abstract: OBJECTIVE
  Trauma care poses many challenges in small hospitals in rural settings. This report was designed to assess the role of a rural general surgeon with trauma patients.
  
  
  METHODS
  A cohort study was designed using a retrospective analysis of a cohort at Bozkır Community Hospital that included trauma patients admitted to the emergency department between June 2007 and May 2009. The patients of group 1 were those treated during the first year of the study period, when the hospital staff was only non-specialist physicians. In the second year, a general surgeon was added to the staff, and the patients from this period constituted group 2.
  
  
  RESULTS
  The top three leading causes of injuries were falls (46.5 %), piercing/cutting injuries (38.2 %), and assault (6.5 %). The frequency of trauma due to falls was higher in group 1, and assault and piercing/cutting injuries were higher in group 2 (p < 0.001 for each). The percentage of discharged and transferred patients was not significantly different between groups (p = 0.065 and p = 0.082, respectively). Similar mortality rates were also detected (group 1: 0.5 %, group 2: 0.3 %, p = 0.479).
  
  
  CONCLUSIONS
  The presence of a solo general surgeon was not found to be adequate for improving the outcome for trauma patients in a rural hospital.
authors.affiliation: Department of General Surgery, Umraniye Education and Research Hospital, Istanbul, Turkey. fatihbasak@gmail.com.|Genel Cerrahi Klinigi Sekreterlik, Elmalikent Mahallesi, Adem Yavuz Cad. No:1 Umraniye, Istanbul, Turkey. fatihbasak@gmail.com.
authors.forename: F
authors.identifier: http://orcid.org/0000-0003-1854-7437
authors.initials: F
authors.lastname: Basak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000458:organization & administration; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D058996:Quality Improvement; D066231:Surgeons; D014421:Turkey; D000078329:Workforce; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery*; D055815:Young Adult
keywords: Rural; Solo surgeon; Trauma; Turkey