信念的飞跃：在二级创伤救治中取消外科医生参与的影响。

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

作者信息

Nwomeh Benedict C, Georges Anthony J, Groner Jonathan I, Haley Kathy J, Hayes John R, Caniano Donna A

机构信息

Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine and Public Health, Children's Hospital, Columbus, OH 43205, USA.

出版信息

J Pediatr Surg. 2006 Apr;41(4):693-9; discussion 693-9. doi: 10.1016/j.jpedsurg.2005.12.011.

DOI:10.1016/j.jpedsurg.2005.12.011

PMID:16567178

Abstract

BACKGROUND

Limitation of resident work hours has created the need to explore alternatives to surgeon presence during initial assessment and resuscitation for selected life-threatening injuries in children. We recently eliminated the requirement for surgeon presence during Level II alerts. The purpose of this study was to evaluate the impact of this change on patient care.

METHODS

A retrospective analysis of trauma alert activity was performed using data from our trauma registry. In March 2003, responsibility for level II alerts was transferred from the pediatric surgeons (PSs) to the Emergency Department (ED) physicians. We compared the activity in the 18-month period before this change (period 1; n = 627) to that afterward (period 2; n = 587). Outcome measures included injury severity score, emergency department length of stay, missed injuries, abdominal computed tomography use, and mortality. Data were analyzed using log-rank statistic, chi2, or t test, where appropriate, with significance level at P < .05.

RESULTS

During the entire study period, 1499 patients met the trauma alert activation criteria of which 1214 (81%) were level II alerts. The mean injury severity score for period 1 (8.5 +/- 7.3 SD) was similar to period 2 (9.0 +/- 7.1 SD). When ED physicians replaced PS for Level II alerts, ED length of stay increased from 135 minutes to 165 minutes (P < .001). In addition, the use of abdominal computed tomography was significantly decreased (53.6% vs 42.6%; P < .001). However, there were no missed injuries and no significant differences in the rate of mortality.

CONCLUSIONS

When ED physicians replaced PS for Level II alerts, trauma room length of stay was increased, but use of abdominal imaging was decreased with no differences in rate of missed injury or mortality. Emergency Department physicians can safely replace PS during Level II alerts. These findings may be useful to institutions experiencing surgical workforce limitations for trauma alerts.

摘要

背景

住院医师工作时间的限制使得有必要探索在对儿童某些危及生命的损伤进行初始评估和复苏期间，替代外科医生在场的方法。我们最近取消了二级警报期间外科医生在场的要求。本研究的目的是评估这一变化对患者护理的影响。

方法

使用我们创伤登记处的数据对创伤警报活动进行回顾性分析。2003年3月，二级警报的责任从儿科外科医生（PSs）转移到了急诊科（ED）医生。我们将这一变化之前的18个月期间（时期1；n = 627）与之后的时期（时期2；n = 587）的活动进行了比较。结果指标包括损伤严重程度评分、急诊科住院时间、漏诊损伤、腹部计算机断层扫描的使用情况以及死亡率。在适当情况下，使用对数秩统计、卡方检验或t检验对数据进行分析，显著性水平为P < 0.05。

结果

在整个研究期间，1499名患者符合创伤警报激活标准，其中1214例（81%）为二级警报。时期1的平均损伤严重程度评分为（8.5 ± 7.3标准差），与时期2（9.0 ± 7.1标准差）相似。当急诊科医生替代儿科外科医生进行二级警报时，急诊科住院时间从135分钟增加到165分钟（P < 0.001）。此外，腹部计算机断层扫描的使用显著减少（53.6%对42.6%；P < 0.001）。然而，没有漏诊损伤，死亡率也没有显著差异。