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Nontrauma surgeons can safely cover the trauma service at a level one trauma center.
*Nathan Louras, *John Fortune, Neil Hyman
University of Vermont, Burlington, VT

Objective: Specific care protocols and systems established by trauma surgeons aid in the acute management of injured patients. It is uncertain whether patient care is as safe and effective when a full time trauma surgeon is not on-call.
Design: Retrospective cohort study
Setting: Academic medical center with Level One Trauma Center
Patients: Patients admitted to the trauma service from 2007-2012
Main Outcome Measures: Mortality, missed injuries, length of stay
Results: Of the 2571 injured patients admitted during the study period, 1,621 were admitted directly to the Trauma service. 1,415 patients were initially seen by a trauma attending on-call and 206 were initially seen by a non-trauma attending on-call. Demographics were similar except that the trauma attending patients were somewhat older (44.7 vs 39.4 years, p=.002). There was no difference in the mean injury severity score (17.0 vs 16.0, p=0.13) or Glasgow Coma Scale (12.7 vs 12.3, p=0.7) for trauma and non-trauma attendings. 128 patients died following admission, of which, 112 (88%) were initially seen by a trauma attending and 16 (12%) were initially seen by a non-trauma attending on-call (p=0.25). There was no difference in the incidence of delayed or missed injuries. The mean length of stay was shorter (7.9 vs 6.3, p=0.016) in the non-trauma attending on-call group.
Conclusions: There was no difference in mortality or missed injuries between trauma and non-trauma attendings taking night call at a level one trauma center. Patients admitted by a trauma attending on-call had an increased length of stay, but were older. Systems of care and algorithms can be developed that allow non-trauma surgeons to provide safe and effective care to trauma patients.


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