Willette Paul A, Beery Paul R, Hartman Jodi F, Wright Michelle L
Mid-Ohio Emergency Services, LLC, Grant Medical Center, Columbus, Ohio 43215, USA.
J Emerg Med. 2010 Sep;39(3):356-65. doi: 10.1016/j.jemermed.2008.10.021. Epub 2009 Mar 9.
Previous studies have examined the impact of the immediate presence of attending trauma surgeons on category I trauma alert activation outcomes.
This study sought to determine if the initial presence of an attending surgeon influences category II trauma activation outcomes.
This 2-year retrospective review of category II alert activations involved a trauma database query to identify patients and extract pertinent variables.
The attending and non-attending groups were comprised of 2192 (67.6%) and 1051 (32.4%) patients, respectively. There was no significant difference in gender, age, emergency department (ED) duration, Intensive Care Unit (ICU) duration, ED disposition, or ICU admission between groups. No significant differences in outcomes, including patient mortality, complication rates, length of stay, and Injury Severity Score, were calculated between groups.
These results lend strength to our category II trauma alert activation criteria and suggest that non-critically injured patients in need of trauma care are receiving appropriate treatment, regardless of who performs the initial evaluation. Comparable successful outcomes support the contention that the mandatory initial presence of an attending trauma surgeon is not necessary for category II activations. Initial evaluation may be performed by an emergency physician alone or by a non-attending surgeon (senior surgical resident or fellow) in conjunction with an emergency physician. Management of category II trauma alert activations should be determined by individual institutions after a thorough evaluation of resources and outcomes.
既往研究探讨了创伤外科主治医生即时在场对I类创伤警报启动结果的影响。
本研究旨在确定主治医生的初始在场是否会影响II类创伤启动结果。
这项对II类警报启动的2年回顾性研究涉及查询创伤数据库以识别患者并提取相关变量。
主治医生在场组和不在场组分别包括2192例（67.6%）和1051例（32.4%）患者。两组在性别、年龄、急诊科停留时间、重症监护病房停留时间、急诊科处置或重症监护病房入院方面无显著差异。两组之间在包括患者死亡率、并发症发生率、住院时间和损伤严重度评分等结果方面无显著差异。
这些结果支持了我们的II类创伤警报启动标准，并表明需要创伤护理的非重伤患者正在接受适当治疗，无论最初评估由谁进行。可比的成功结果支持这样的观点，即II类启动时创伤外科主治医生的强制初始在场并非必要。初始评估可由急诊医生单独进行，或由非主治医生（高级外科住院医师或专科住院医师）与急诊医生联合进行。II类创伤警报启动的管理应由各机构在对资源和结果进行全面评估后确定。
