The impact of managing moderately injured pediatric trauma patients without immediate surgeon presence

Purpose

The purpose of this study was to determine the outcome of “minor resuscitation” trauma patients managed without the immediate presence of a surgeon.

Methods

In 2003, our hospital replaced surgeons with pediatric emergency medicine physicians for level 2 (minor resuscitation) trauma alerts, whereas the level 1 (major resuscitation) alerts remained surgeon directed. We compared patients treated in the 3 years before (period 1) and after (period 2) this change. Patient records were analyzed for discharges, alert upgrades, Injury Severity Score (ISS), time to destination, and mortality.

Results

There were 918 admissions and 93 discharges in period 1 compared with 815 admissions and 652 discharges in period 2. In period 1, 3% were upgraded to level 1 status compared with 9% in period 2 (P < .0001). The mean ISS of admitted patients and the percentage of critical (ISS >15) patients were greater in period 2 (P < .001). The time to inpatient floor was longer in period 2, but the elapsed times to operating room and to pediatric intensive care unit were not significantly different.

Conclusion

Pediatric emergency medicine physicians discharged more patients than the surgeons, but also upgraded more to level 1 status. Level 2 trauma patients can be safely managed without immediate surgeon presence.