Availability of Trauma Specialists in Level I and II Trauma Centers: A National Survey

Abstract

There was a large variation in the availability of expertise at or shortly after a trauma admission. For centers with low patient volume, early triage, better notification systems based on advanced telecommunication technology, and compensation for IH call may be a solution to better use the trauma surgical specialties.

Assessing trauma care provider judgement in the prediction of need for life-saving interventions

“…In addition, the attending physicians and fellows were not necessarily in the TRU admission space itself when the patient arrived but were paged from other clinical duties, thus delaying their timely responses. In a study by Kim et al, among 245 Level I and II trauma centres in the United States, 82% had trauma surgeons available within 15 min of patient admission [19]. Therefore, having survey responses completed by 100% of physician leaders within 15 min and 80% within 10 min would exceed an expected timely survey completion rate at most U.S. trauma centres.…”

“…Mean Injury Severity Scores (ISS) were 13.0 (SD 13.2) [interquartile range, [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. Injuries included 19% penetrating injuries and 78% blunt injuries (Table 1).…”

“…Cohen's kappa statistic for agreement between pairs of provider groups demonstrated no ''disagreement'' (K < 0) between groups, ''fair'' agreement for fluid bolus (K = 0.12-0. 19) and blood transfusion 0-6 h (K = 0.22-0.39), and ''moderate'' (K = 0.45-0.49) agreement between PHP and RN regarding intubation and surgical interventions, but no ''excellent'' (K 0.81) agreement between any pair of provider groups for any intervention. The percentage agreement across the different clinician groups ranged from 50% to 83%.…”

Comparison of Decision-Assist and Clinical Judgment of Experts for Prediction of Lifesaving Interventions

“…The patient cohort studied was representative of the entire trauma center population with respect to the incidence of blood transfusion of 7.4%; this was within the 6% to 8% incidence of the overall trauma center transfusion rate (29), indicating that the patients studied were similar to that of the overall trauma center population. The PPG waveform recording during resuscitation in the trauma center has many technical challenges, such as sensor dislodgment, artifact, inability to obtain a signal during poor peripheral perfusion, in patients with cool extremities, and so on so may limit application of the algorithm to all trauma patient resuscitations.…”

Surgical Trauma Referrals From Rural Level III Hospitals: Should Our Community Colleagues be Doing More, or Less?

“…[7][8][9][10] Although these discrepancies are significant, the care of the rural trauma victim has only recently begun to achieve an increased focus at both local and national levels. 1,11,12 Unfortunately, the factors conspiring to challenge optimal treatment of a rural trauma patient are multiple and varied. [13][14][15][16][17][18] Perhaps, the most significant issue is that caring for a severely injured patient is a relatively infrequent event in the presence of a mature prehospital system.…”