Is routine trauma surgeon presence in the emergency department necessary for all priority one trauma cases?
Date
2014-08-25
Authors
Nay, Harry Roy
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Abstract
Objectives:
The majority of injured patients transported to hospital ED’s do not require
emergency surgery, yet our protocols require a surgeon to be present on their
arrival. There is a drive to develop clinical decision rules so as to apply “secondary
triage” criteria to trauma patients in the hope that there can be more efficient use
of the surgeons’ time. My objective was to identify the proportion of trauma
patients that required emergency trauma surgeon intervention within 60 minutes of
patient arrival.
Design:
A retrospective study of all Priority 1 trauma patients that presented to the ED of
three Level 1 trauma centres in three private hospitals in Johannesburg. These
units are staffed with ED doctors experienced in trauma management and backed
up by either specialist trauma surgeons or surgeons experienced in trauma
management.
Methods:
We analysed data from 4,500 patients in our trauma centre registry (TraumaBank).
We identified emergency procedural intervention and emergency operative
intervention (within one hour) by a general surgeon.
Main Results:
Emergency operative intervention occurred in 2.7% of cases and emergency
procedural intervention occurred in 0.8% of cases. Existing triage and secondary
triage systems performed poorly with unacceptable over and under-triage.
Conclusions:
Routine surgeon presence during the initial phase of the management of trauma
patients is hard to justify. Triage policies need to strike a balance between
resources and optimal care. To identify those patients that require emergency
operative intervention by trauma surgeons based on pre-arrival triage criteria
alone, we need to look primarily at truncal penetrating injury, persistent shock and
patients transferred from other facilities.