A leap in faith: the impact of removing the surgeon from the level II trauma response

Evolving Roles of the Surgeon in the Management of Pediatric Trauma Resuscitation

“…The median trauma room length of stay was 165 min when the PEM team led the traumas compared to 135 min before the change (P \ 0.001) and the PEM obtained significantly fewer abdominal CT scans (53.6 % compared to 42.6 %, P \ 0.001). There was no statistical difference in mortality (P = 0.2) [22]. Amputation, near amputation, or degloving injury (any of these to more than fingers or toes)…”

“…Injury type alone is not effective for triage. A tiered triage system is crucial and multiple trauma institutions have demonstrated the cost effectiveness and safety of such a system to reduce surgeon involvement while preserving quality patient care [4,[21][22][23]26]. Our system of using PEM physicians alone is for minor trauma resuscitations and does not include major resuscitations.…”

“…The impetus to change from surgeon-led to PEM physician-led minor trauma resuscitations for our institution came in 2003 with the advent of work-hour restrictions by the Accreditation Council for Graduate Medical Education (ACGME). Our subsequent outcomes have shown no change in the rate of missed injuries or mortality after implementation [22]. Other institutions have since adopted this model and have also demonstrated the efficacy of this triage system and PEMled minor resuscitation alerts [25 • ].…”

Organization of clinical emergency units

“…[28] wurde eine Rufzeit von 15 min im Vergleich zur Präsenz auf der Notfallstation als ausreichend nachgewiesen.…”

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

“…At our institution, we established a triage system that directed the pediatric emergency medicine (PEM) physicians to be the first responders for children with non-life-threatening injuries, thereby replacing the senior-level residents in general surgery and the fellows in pediatric surgery for this specific group of patients. We demonstrated that this new triage system resulted in no change in the rate of missed injuries and no increase in mortality [2]. Because these are relatively crude performance measures, we undertook the current study to determine the disposition and outcome of all injured children who were triaged to first response and management by a PEM physician-led trauma team.…”