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

Groner, Judith A.; Covert, Julia; Lowell, Wendi; Hayes, John R.; Nwomeh, Benedict C.; Caniano, Donna A.

doi:10.1016/j.jpedsurg.2007.01.037

Cited by 8 publications

(8 citation statements)

References 8 publications

(9 reference statements)

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“…Just as important, PEM-led minor resuscitation trauma has been associated with a decreased admission rate from 91 to 55 % [23]. We believe that this likely reflects important differences in how decisions on patients' disposition were made before and after the implementation of the new trauma activation model.…”

Section: Discussionmentioning

confidence: 95%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…The time elapsed from the emergency department (ED) to the operating room (OR) and from ED to pediatric intensive care unit (PICU) was not statistically different, and mortality was not statistically different for both periods. PEM-led level 2 traumas led to fewer abdominal CT scans (P \ 0.001), decreased the admission rate from 91 to 55 % (P \ 0.0001), but no missed abdominal injuries were found in either period [23].…”

Section: A Model Of Pediatric Emergency Medicine-led Minor Trauma Actmentioning

confidence: 99%

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

et al. 2015

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The traditional paradigm for trauma resuscitations was that a surgeon was always required for leadership. However many changes such as resident work-hour limitations, a shift toward non-operative management, improved trauma triage, and advanced imaging have raised questions about the necessity of a member of the surgical team at all resuscitations. The requirement for surgeon presence is based mostly on opinion rather than data. Our institution has over a decade of experience with pediatric emergency medicine physicians managing minor trauma resuscitations and requiring surgeon presence specifically for the major resuscitations. This has resulted in more appropriate resource allocation without sacrificing patient care in our institution. Other institutions have similarly shifted the focus away from early surgeon involvement while preserving patient safety. We recommend a critical re-evaluation of trauma protocols and systems in requiring surgeon presence as a novel mechanism to improve surgical resource utilization without compromising patient care.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: A Model Of Pediatric Emergency Medicine-led Minor Trauma Actmentioning

confidence: 99%

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

et al. 2015

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“…These guidelines have implications for training of EM residents who may not have the opportunity to acquire team leadership skills in trauma resuscitation. The requirement that surgeons need to present during trauma activations has been questioned [ 7 , 18 , 31 - 33 ].…”

Section: Role Of Emp's In Trauma Carementioning

confidence: 99%

“…Within the past five years several reports have been published in Canada and the USA suggesting that the presence of a surgeon at both adult and pediatric trauma resuscitations is superfluous [ 7 , 31 - 33 ]. Most of these reports describe the role of the EMP in team leadership during the resuscitative phase of care.…”

Section: Role Of Emp's In Trauma Carementioning

confidence: 99%

The role of emergency medicine physicians in trauma care in North America: evolution of a specialty

Grossman

2009

Scand J Trauma Resusc Emerg Med

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The role of Emergency Medicine Physicians (EMP) in the care of trauma patients in North America has evolved since the advent of the specialty in the late 1980's. The evolution of this role in the context of the overall demands of the specialty and accreditation requirements of North American trauma centers will be discussed. Limited available data published in the literature examining the role of EMP's in trauma care will be reviewed with respect to its implications for an expanded role for EMPs in trauma care. Two training models currently in the early stages of development have been proposed to address needs for increased manpower in trauma and the critical care of trauma patients. The available information regarding these models will be reviewed along with the implications for improving the care of trauma patients in both Europe and North America.

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Trauma surgeon becomes consultant: Evaluation of a protocol for management of intermediate-level trauma patients

Fallon

Christopher

Frost

et al. 2014

Journal of Pediatric Surgery

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

Cited by 8 publications

References 8 publications

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

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

The role of emergency medicine physicians in trauma care in North America: evolution of a specialty

Trauma surgeon becomes consultant: Evaluation of a protocol for management of intermediate-level trauma patients

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