院内与随叫随到创伤外科医生覆盖范围：系统评价和荟萃分析。
In-house versus on-call trauma surgeon coverage: A systematic review and meta-analysis.
机构信息
From the Department of Surgery (A.C.J.d.l.M., R.D.L., J.F.W., Y.O., Q.M.J.v.d.V., F.H., R.M.H., M.v.H., L.P.H.L.), University Medical Center Utrecht, Utrecht; Department of Clinical Epidemiology (Y.O.), Leiden University Medical Center, Leiden; and Department of Surgery (M.v.H.), Diakonessenhuis, Zeist, Doorn, Utrecht, the Netherlands.
出版信息
J Trauma Acute Care Surg. 2021 Aug 1;91(2):435-444. doi: 10.1097/TA.0000000000003226.
BACKGROUND
A rapid trauma response is essential to provide optimal care for severely injured patients. However, it is currently unclear if the presence of an in-house trauma surgeon affects this response during call and influences outcomes. This study compares in-hospital mortality and process-related outcomes of trauma patients treated by a 24/7 in-house versus an on-call trauma surgeon.
METHODS
PubMed/Medline, Embase, and CENTRAL databases were searched on the first of November 2020. All studies comparing patients treated by a 24/7 in-house versus an on-call trauma surgeon were considered eligible for inclusion. A meta-analysis of mortality rates including all severely injured patients (i.e., Injury Severity Score of ≥16) was performed. Random-effect models were used to pool mortality rates, reported as risk ratios. The main outcome measure was in-hospital mortality. Process-related outcomes were chosen as secondary outcome measures.
RESULTS
In total, 16 observational studies, combining 64,337 trauma patients, were included. The meta-analysis included 8 studies, comprising 7,490 severely injured patients. A significant reduction in mortality rate was found in patients treated in the 24/7 in-house trauma surgeon group compared with patients treated in the on-call trauma surgeon group (risk ratio, 0.86; 95% confidence interval, 0.78-0.95; p = 0.002; I2 = 0%). In 10 of 16 studies, at least 1 process-related outcome improved after the in-house trauma surgeon policy was implemented.
CONCLUSION
A 24/7 in-house trauma surgeon policy is associated with reduced mortality rates for severely injured patients treated at level I trauma centers. In addition, presence of an in-house trauma surgeon during call may improve process-related outcomes. This review recommends implementation of a 24/7 in-house attending trauma surgeon at level I trauma centers. However, the final decision on attendance policy might depend on center and region-specific conditions.
LEVEL OF EVIDENCE
Systematic review/meta-analysis, level III.
背景
快速的创伤反应对于为严重受伤的患者提供最佳护理至关重要。然而，目前尚不清楚内部创伤外科医生的存在是否会影响呼叫期间的这种反应，并影响结果。本研究比较了由 24/7 内部与随叫随到的创伤外科医生治疗的创伤患者的院内死亡率和与过程相关的结局。
方法
于 2020 年 11 月 1 日在 PubMed/Medline、Embase 和 CENTRAL 数据库中进行检索。所有比较由 24/7 内部与随叫随到的创伤外科医生治疗的患者的研究均被认为符合纳入标准。对所有严重受伤患者（即损伤严重程度评分≥16）进行了死亡率的荟萃分析。使用随机效应模型汇总死亡率，报告为风险比。主要观察指标是院内死亡率。选择与过程相关的结局作为次要观察指标。
结果
共纳入了 16 项观察性研究，共纳入了 64337 名创伤患者。荟萃分析纳入了 8 项研究，包括 7490 名严重受伤患者。与随叫随到的创伤外科医生组相比，接受 24/7 内部创伤外科医生治疗的患者的死亡率显著降低（风险比，0.86；95%置信区间，0.78-0.95；p = 0.002；I2 = 0%）。在 16 项研究中的 10 项中，实施内部创伤外科医生政策后，至少有 1 项与过程相关的结局得到了改善。
结论
24/7 内部创伤外科医生政策与 I 级创伤中心治疗的严重受伤患者的死亡率降低相关。此外，在呼叫期间有内部创伤外科医生可能会改善与过程相关的结局。本综述建议在 I 级创伤中心实施 24/7 内部主治创伤外科医生。然而，出勤政策的最终决定可能取决于中心和区域的具体情况。
证据水平
系统评价/荟萃分析，III 级。
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