Citation

van Wessem KJP, Leenen LPH, Houwert RM, Benders KEM, Simmermacher RKJ, van Baal MCPM, de Bruin IGJM, de Jong MB, Nijs SJB, Hietbrink F. Scand. J. Trauma Resusc. Emerg. Med. 2023; 31(1): e60.

Copyright

(Copyright © 2023, Scandinavian Networking Group on Trauma and Emergency Management, Publisher Holtzbrinck Springer Nature Publishing Group - BMC)

DOI

10.1186/s13049-023-01122-9

PMID

37880795

PMCID

PMC10598943

Abstract

BACKGROUND: The presence of in-house attending trauma surgeons has improved efficiency of processes in the treatment of polytrauma patients. However, literature remains equivocal regarding the influence of the presence of in-house attendings on mortality. In our hospital there is a double trauma surgeon on-call system. In this system an in-house trauma surgeon is 24/7 backed up by a second trauma surgeon to assist with urgent surgery or multiple casualties. The aim of this study was to evaluate outcome in severely injured patients in this unique trauma system.

METHODS: From 2014 to 2021, a prospective population-based cohort consisting of consecutive polytrauma patients aged ≥ 15 years requiring both urgent surgery (≤ 24h) and admission to Intensive Care Unit (ICU) was investigated. Demographics, treatment, outcome parameters and pre- and in-hospital transfer times were analyzed.

RESULTS: Three hundred thirteen patients with a median age of 44 years (71% male), and median Injury Severity Score (ISS) of 33 were included. Mortality rate was 19% (68% due to traumatic brain injury). All patients stayed ≤ 32 min in ED before transport to either CT or OR. Fifty-one percent of patients who needed damage control surgery (DCS) had a more deranged physiology, needed more blood products, were more quickly in OR with shorter time in OR, than patients with early definitive care (EDC). There was no difference in mortality rate between DCS and EDC patients. Fifty-six percent of patients had surgery during off-hours. There was no difference in outcome between patients who had surgery during daytime and during off-hours. Death could possibly have been prevented in 1 exsanguinating patient (1.7%).

CONCLUSION: In this cohort of severely injured patients in need of urgent surgery and ICU support it was demonstrated that surgical decision making was swift and accurate with low preventable death rates. 24/7 Physical presence of a dedicated trauma team has likely contributed to these good outcomes.

Language: en

Keywords

Adult; Humans; Female; Male; Prospective Studies; Mortality; Injury Severity Score; Retrospective Studies; *Multiple Trauma/surgery; *Surgeons; *Wounds and Injuries/surgery; Double trauma surgeon on-call service; Intensive Care Units; Polytrauma; Trauma Centers