A. Ansari1, A. Kothari1, E. Eguia1, M. Anstadt1, R. Gonzalez1, F. Luchette1, P. Patel1 1Loyola University Chicago Stritch School Of Medicine,Department Of Surgery,Maywood, IL, USA
Introduction:
Trauma is the fourth leading cause of death in the United States. Care in level 1 trauma centers is associated with improved outcomes and the determinants of this relationship continue to be studied. The objective of this study was to determine if the number of trauma surgeons on staff at level 1 trauma centers impacted outcomes.
Methods:
This study utilized data from the American College of Surgeon’s (ACS) National Trauma Data Bank (NTDB) for years 2013-2016. Inclusion criteria was set as all patient presenting to a Level 1 trauma centers with severe traumatic injuries defined as an Injury Severity Score (ISS) of 15 or greater. The primary outcome was patient survival. A multivariable logistic regression model was constructed to estimate the adjusted effect of trauma surgeon staffing on the primary outcome.
Results:
A total of 180,999 encounters were included in this study. Injured patients that received care at a trauma center with less than 4 staff surgeons had a mortality of 16.0% vs those at a trauma center with > 4 surgeons 12.4% (P=0.01). After controlling for injury severity, age, sex, and race, the odds of mortality were 0.70 (95% CI 0.53 – 0.92) comparing high staff to low staff centers. Secondary outcomes, including length of stay, ventilator time, and ICU length of stay did not differ based on trauma center staffing.
Conclusion:
Current ACS requirements for trauma surgeon staffing at Level 1 trauma centers require that there be a minimum of one trauma surgeon per center. Based on our evaluation, there seems to be clinical improvement in outcomes when a center has 4 or greater trauma surgeons on staff. This warrants further evaluation at the requirements for trauma surgeon staffing at level 1 trauma centers.