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Menchetti I, Muzzo M, Malo C, Ackery A, Nemeth J, Rao J, Engels PT, Vogt K, Razek T, Beckett A, da Luz L. Who are the trauma team leaders across Canada? A national survey evaluating the profession in adult and pediatric level one trauma centres. CAN J EMERG MED 2023; 25:959-967. [PMID: 37853308 DOI: 10.1007/s43678-023-00607-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Trauma Team Leaders (TTLs) are critical for coordinating and leading trauma resuscitations. This survey sought to characterize the demographics and professional practices of Canadian TTLs at level one trauma centres. As a secondary objective, this information will be utilized to inform the operational goals of the Trauma Association of Canada (TAC) TTL Committee. METHODS A detailed survey, developed by the TAC board of directors and TTL committee leads, was sent to 225 TTLs across Canada's level one trauma centres. TTLs were identified via contacting trauma directors at each level one centre, in addition to public registry searches. This survey captured demographics, professional background, resuscitation practices, trauma team composition, and TTL involvement in trauma responses. RESULTS The response rate was 41.7%. Mean respondent age was 42 (SD 7.4) and 71.0% were male. Most TTLs trained in emergency medicine (53.1%) or general surgery (25.5%); 63.8% underwent TTL training: either via a trauma surgery fellowship or TTL fellowship. All centres have a massive hemorrhage protocol implemented, and there is no large variation between the rates of use of cryoprecipitate and fibrinogen, nor the ratio of blood products transfused (2:1 vs 1:1). Most TTL respondents intend to participate in a TTL group associated with TAC (85.1%). CONCLUSION The results of this survey will contribute to the recognition of TTLs as a crucial role in the initial phase of care of severely injured trauma patients and serves as the first publication to document professional backgrounds and practices of Canadian TTLs at level one trauma centres. All the information gathered via this survey will be used by the TAC TTL Committee, which will focus on several initiatives such as the dissemination of best practice guidelines and creation of a TTL stream at the TAC Annual Conference.
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Affiliation(s)
- Isabella Menchetti
- Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
| | - Madison Muzzo
- Department of Neuroscience, Northeastern University, Boston, MA, USA
| | - Christian Malo
- Department of Emergency Medicine, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Alun Ackery
- Department of Emergency Medicine, St Michael's Hospital, Toronto, ON, Canada
| | - Joe Nemeth
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
| | - Jagadish Rao
- Department of Surgery, University of Saskatchewan, Regina, SK, Canada
| | - Paul T Engels
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Kelly Vogt
- Department of Surgery, London Health Sciences Centre, London, ON, Canada
| | - Tarek Razek
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Andrew Beckett
- Department of General Surgery, St Michael's Hospital, Toronto, ON, Canada
| | - Luis da Luz
- Department of General Surgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Boivin Z, Xu C, Doko D, Herbst MK, She T. Prevalence of Phantom Scanning in Cardiac Arrest and Trauma Resuscitations: The Scary Truth. POCUS JOURNAL 2023; 8:217-222. [PMID: 38099175 PMCID: PMC10721300 DOI: 10.24908/pocus.v8i2.16690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Background: The prevalence of phantom scanning, or point of care ultrasound (POCUS) performed without saving images, has not been well studied. Phantom scanning can negatively affect patient care, reduce billed revenue, and can increase medicolegal liability. We sought to quantify and compare the prevalence of phantom scanning among emergency department (ED) cardiac arrests and trauma resuscitations. Methods: This was a single center, retrospective cohort study from July 1, 2019, to July 1, 2021, of all occurrences of POCUS examination documented on the resuscitation run sheet during cardiac arrest and trauma resuscitations. Two investigators reviewed the run sheets to screen for POCUS documentation. Instances where documentation was present were matched with saved images in the picture archiving and communication system. Instances where documentation was present but no images could be located were considered phantom scans. A two-tailed student's t test was utilized to compare the phantom scanning rate between cardiac arrest and trauma resuscitations. Results: A total of 1,862 patients were included in the study period, with 329 cardiac arrests and 401 trauma resuscitations having run sheet documentation of POCUS performance. The phantom scanning rate in cardiac arrests and trauma resuscitations was 70.5% (232/329) and 86.5% (347/401), respectively (p < 0.001). Conclusion: Phantom scanning is common in both cardiac arrests and trauma resuscitations in the ED at our institution, but is significantly higher in trauma resuscitations. Further research is needed to assess causes and develop potential solutions to reduce the high prevalence of phantom scanning.
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Affiliation(s)
- Zachary Boivin
- University of Connecticut Emergency Medicine Residency, University of Connecticut School of MedicineFarmington, CTUSA
| | - Curtis Xu
- University of Connecticut Emergency Medicine Residency, University of Connecticut School of MedicineFarmington, CTUSA
| | - Donias Doko
- University of Connecticut Emergency Medicine Residency, University of Connecticut School of MedicineFarmington, CTUSA
| | - Meghan Kelly Herbst
- Department of Emergency Medicine, University of Connecticut School of MedicineFarmington, CTUSA
| | - Trent She
- Department of Emergency Medicine, Hartford HospitalHartford, CTUSA
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Taylor J, Gezer R, Ivkov V, Erdogan M, Hejazi S, Green R, Tallon JM, Tuyp B, Thakore J, Engels PT, Ackery A, Beckett A, Vogt K, Parry N, Heyd C, Coates A, Lampron J, MacPhail I. Do patient outcomes differ when the trauma team leader is a surgeon or non-surgeon? A multicentre cohort study. CAN J EMERG MED 2023:10.1007/s43678-023-00516-z. [PMID: 37184823 DOI: 10.1007/s43678-023-00516-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
PURPOSE Trauma team leaders (TTLs) have traditionally been general surgeons; however, some trauma centres use a mixed model of care where both surgeons and non-surgeons (primarily emergency physicians) perform this role. The objective of this multicentre study was to provide a well-powered study to determine if TTL specialty is associated with mortality among major trauma patients. METHODS Data were collected from provincial trauma registries at six level 1 trauma centres across Canada over a 10-year period. We included adult trauma patients (age ≥ 18 yrs) who triggered the highest-level trauma activation. The primary outcome was the difference in risk-adjusted in-hospital mortality for trauma patients receiving initial care from a surgeon versus a non-surgeon TTL. RESULTS Overall, 12,961 major trauma patients were included in the analysis. Initial treatment was provided by a surgeon TTL in 57.8% (n = 7513) of cases, while 42.2% (n = 5448) of patients were treated by a non-surgeon TTL. Unadjusted mortality occurred in 11.6% of patients in the surgeon TTL group and 12.7% of patients in the non-surgeon TTL group (OR 0.87, 95% CI 0.78-0.98, p = 0.02). Risk-adjusted mortality was not significantly different between patients cared for by surgeon and non-surgeon TTLs (OR 0.92, 95% CI 0.80-1.06, p = 0.23). Furthermore, we did not observe differences in risk-adjusted mortality for any of the subgroups evaluated. CONCLUSIONS After risk adjustment, there was no difference in mortality between trauma patients treated by surgeon or non-surgeon TTLs. Our study supports emergency physicians performing the role of TTL at level 1 trauma centres.
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Affiliation(s)
- John Taylor
- Royal Columbian Hospital Emergency Department, New Westminster, BC, Canada.
| | | | - Vesna Ivkov
- Emergency and Trauma, Fraser Health Authority, Surrey, BC, Canada
| | - Mete Erdogan
- NS Health Trauma Program, Implementation Science, Nova Scotia Health, Halifax, NS, Canada
| | - Samar Hejazi
- Department of Evaluation and Research Services, Fraser Health Authority, Surrey, BC, Canada
| | - Robert Green
- Departments of Critical Care, Emergency Medicine, Anesthesia, and Surgery, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Trauma Program, Nova Scotia Health, Halifax, NS, Canada
| | - John M Tallon
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- Departments of Community Health and Epidemiology, Anesthesia and Surgery, Dalhousie University, Halifax, NS, Canada
| | | | - Jaimini Thakore
- Data, Evaluation and Analytics, Trauma Services BC, Fort Langley, BC, Canada
| | - Paul T Engels
- Trauma, General Surgery and Critical Care, Trauma and Acute Care Surgery, McMaster University, Hamilton, ON, Canada
| | - Alun Ackery
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Trauma and Neurosurgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew Beckett
- University of Toronto, Toronto, ON, Canada
- Canadian Forces Health Services, Ottawa, ON, Canada
| | - Kelly Vogt
- Western University, London, ON, Canada
- Trauma Program, London Health Sciences Centre, London, ON, Canada
| | - Neil Parry
- Trauma Program, Surgery and Critical Care Medicine, Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, London Health Sciences Centre, Western University, London, ON, Canada
| | - Christopher Heyd
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Angela Coates
- Trauma Program Manager, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jacinthe Lampron
- General Surgery, Acute Care and Trauma, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Iain MacPhail
- Fraser Health Trauma Network, UBC, Vancouver, BC, Canada
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Sodhi K, Khasne RW, Chanchalani G, Jagathkar G, Kola VR, Mishra M, Sahasrabudhe S, Mishra RC, Patel A, Bhavsa AR, Abbas H, Routray PK, Sood P, Rajhans PA, Gupta R, Soni KD, Kumar M. Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey. Indian J Crit Care Med 2023; 27:38-51. [PMID: 36756477 PMCID: PMC9886050 DOI: 10.5005/jp-journals-10071-24384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 01/02/2023] Open
Abstract
Background Trauma is the leading cause of death in India resulting in a significant public health burden. Indian Society of Critical Care Medicine (ISCCM) has established a trauma network committee to understand current practices and identify the gaps and challenges in trauma management in Indian settings. Material and methods An online survey-based, cross-sectional, descriptive study was conducted with high-priority research questions based on hospital profile, resource availability, and trauma management protocols. Results Data from 483 centers were analyzed. A significant difference was observed in infrastructure, resource utilization, and management protocols in different types of hospitals and between small and big size hospitals across different tier cities in India (p < 0.05). The advanced trauma life support (ATLS)-trained emergency room (ER) physician had a significant impact on infrastructure organization and trauma management protocols (p < 0.05). On multivariate analysis, the highest impact of ATLS-trained ER physicians was on the use of extended focused assessment with sonography in trauma (eFAST) (2.909 times), followed by hospital trauma code (2.778 times), dedicated trauma team (1.952 times), and following trauma scores (1.651 times). Conclusion We found that majority of the centers are well equipped with optimal infrastructure, ATLS-trained physician, and management protocols. Still many aspects of trauma management need to be prioritized. There should be proactive involvement at an organizational level to manage trauma patients with a multidisciplinary approach. This survey gives us a deep insight into the current scenario of trauma care and can guide to strengthen across the country. How to cite this article Sodhi K, Khasne RW, Chanchalani G, Jagathkar G, Kola VR, Mishra M et al. Practice Patterns and Management Protocols in Trauma across Indian Settings: A Nationwide Cross-sectional Survey. Indian J Crit Care Med 2023;27(1):38-51.
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Affiliation(s)
| | - Ruchira Wasudeo Khasne
- Department of Critical Care Medicine, SMBT Institute of Medical Sciences and Research Centre, Dhamangaon, Igatpuri, Nashik, Maharashtra, India,Ruchira Wasudeo Khasne, Department of Critical Care Medicine, SMBT Institute of Medical Sciences and Research Centre, Dhamangaon, Igatpuri, Nashik, Maharashtra, India, Phone: +91 7020272240, e-mail:
| | - Gunjan Chanchalani
- Department of Critical Care, KJ Somaiya Hospital & Research Center, Mumbai, Maharashtra, India
| | - Ganshyam Jagathkar
- Department of Critical Care, Medicover Hospital, Hyderabad, Telangana, India
| | - Venkat Raman Kola
- Department of Critical Care, Yashoda Hospitals, Hyderabad, Telangana, India
| | - Mahesh Mishra
- Department of Surgery, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, Rajasthan, India
| | - Shrikant Sahasrabudhe
- Department of Pulmonology and Critical Care Medicine, Medicover Hospitals, Aurangabad, Maharashtra, India
| | - Rajesh C Mishra
- Department of MICU, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India
| | - Amrish Patel
- Department of Pulmonary and Critical Care Medicine, Sterling Hospital, Ahmedabad, Gujarat, India
| | - Ankur R Bhavsa
- Department of Critical Care, Spandan Multi Specialty Hospital, Vadodara, Gujarat, India
| | - Haider Abbas
- Department of Emergency Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | | | - Pramod Sood
- Department of Critical Care Medicine, Dayanand Medical College & Hospital, Ludhiana, Punjab, India
| | - Prasad Anant Rajhans
- Department of Critical Care and Emergency Medicine, Deenanath Mangeshkar Hospital & Research Center, Pune, Maharashtra, India
| | - Reshu Gupta
- Department of Critical Care Medicine, Health City Hospital, Guwahati, Assam, India
| | - Kapil Dev Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Manender Kumar
- Department of Cardiac Anaesthesia, Fortis Hospital, Ludhiana, Punjab, India
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Emergency medicine (EM) can safely manage geriatric trauma patients sustaining ground level falls: Fostering EM autonomy while safely offloading a busy trauma service. Am J Surg 2022; 224:1314-1318. [DOI: 10.1016/j.amjsurg.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/26/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022]
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Kelley KC, Alers A, Bendas C, Thomas PG, Cipolla J, Hoey BA, Hoff WS, Wilde-Onia R, Weber H, Stawicki SP. Emergency Trauma Providers as Equal Partners: From “Proof of Concept” to “Outcome Parity”. Am Surg 2019. [DOI: 10.1177/000313481908500936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Enmeshment of emergency trauma providers (ETPs) into the United States health-care fabric resulted in the establishment of a formalized surgical critical care fellowship and certification for emergency medicine trainees. The aim of this study was to compare trauma outcomes for surgery-trained providers (STPs) and ETPs at our institution, hypothesizing patient outcome equivalency. We performed an institutional review board–exempt institutional registry review (January 1, 2004 to August 1, 2018), comparing 74 STPs and 6 ETPs. Comparator variables included all-cause mortality, all-cause morbidity, CTimaging studies per provider, time in ED (min), hospital/ICU lengths of stay, ICU admissions, and functional outcomes on discharge. Statistical comparisons included chi-square test for categorical data and analysis of covariance for continuous data (adjustments made for patient age, Injury Severity Score, and trauma mechanism; all P < 0.20). Statistical significance was set at P < 0.05, with an equivalence study design. A total of 33,577 trauma resuscitations were reviewed (32,299 STP-led and 1,278 ETP-led). Except for patient age (STP 50.2 ± 25.9 vs ETP 54.9 ± 25.3 years), Injury Severity Score (8.47 ± 8.14 vs 9.22 ± 8.40), and ICU admissions (16.1% vs 18.8%), we noted no significant intergroup differences. ETPs’ performance was equivalent to that of STPs for all primary comparator variables (mortality, morbidity, CT utilization, time in the ED, lengths of stay, and functional outcomes). Incorporation of ETPs into our trauma center resulted in outcome parity between ETPs and STPs, while simultaneously expanding the expertise and experiential diversity within our multidisciplinary team. This study provides support for further incorporation of ETPs as equal partners across the growing network of United States regional trauma centers.
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Affiliation(s)
- Kathryn C. Kelley
- From the St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Alex Alers
- From the St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Charles Bendas
- From the St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Peter G. Thomas
- From the St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - James Cipolla
- From the St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - Brian A. Hoey
- From the St. Luke's University Health Network, Bethlehem, Pennsylvania
| | - William S. Hoff
- From the St. Luke's University Health Network, Bethlehem, Pennsylvania
| | | | - Holly Weber
- From the St. Luke's University Health Network, Bethlehem, Pennsylvania
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Ahuja R, Tiwari G, Bhalla K. Going to the nearest hospital vs. designated trauma centre for road traffic crashes: estimating the time difference in Delhi, India. Int J Inj Contr Saf Promot 2019; 26:271-282. [PMID: 31240990 DOI: 10.1080/17457300.2019.1626443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Time to hospital after a road traffic crash (RTC) plays a vital role in determining the outcome for crash victims. In Delhi, there are seven designated trauma centres where crash victims are typically taken, which may not be nearest hospital. We compare the transport time access (crash to hospital) depending on whether the victim is transported to a designated trauma centre or the nearest hospital. Data and methods: For each RTC geocoded manually from police records, the nearest hospital and the designated trauma centre is identified using Google Maps places nearby Search API and guidelines. Travel time matrix is generated between RTC's and identified hospitals using Google maps distance matrix API. Index accounting inter-district differences is developed. Results and conclusions: The network of designated trauma centres in New Delhi is located such that they can be accessed within 45 min of most crashes while nearest hospital within 30 min. As a result, the vast majority of crash victims are likely to receive timely care if they are rapidly transferred to either of these caregivers. However, for the most severely injured and time-sensitive cases, bypassing nearest hospital for trauma care, could substantially improve survival outcomes.
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Affiliation(s)
- Richa Ahuja
- a Transportation Research Injury Prevention Programme(TRIPP), Indian Institute of Technology , Delhi , India
| | - Geetam Tiwari
- b Department of Civil Engineering, Indian Institute of Technology , Delhi , India
| | - Kavi Bhalla
- c Department of Public Health Sciences, The University of Chicago , IL , USA
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Allen B, Callaway D, Gibbs M, Noste E, West K, Johnson MA, Caro D, Godwin A. Regarding the Joint Statement From the American College of Surgeons Committee on Trauma and the American College of Emergency Physicians Regarding the Clinical Use of Resuscitative Endovascular Balloon Occlusion of the Aorta. J Emerg Med 2018; 55:266-268. [PMID: 29937072 DOI: 10.1016/j.jemermed.2018.01.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 01/28/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Bryant Allen
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - David Callaway
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael Gibbs
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Erin Noste
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Kathryn West
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - M Austin Johnson
- Department of Emergency Medicine, University of California-Davis Medical Center, Sacramento, California
| | - David Caro
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida
| | - Andrew Godwin
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida
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Allen BK, Callaway DW, Gibbs M, Noste E, West K, Johnson MA, Caro D, Godwin A. Regarding the 'Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)'. Trauma Surg Acute Care Open 2018; 3:e000168. [PMID: 29767642 PMCID: PMC5887825 DOI: 10.1136/tsaco-2018-000168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 02/19/2018] [Indexed: 12/02/2022] Open
Affiliation(s)
- Bryant K Allen
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - David W Callaway
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Michael Gibbs
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Erin Noste
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - Kathryn West
- Department of Emergency Medicine, Carolinas Medical Center, Charlotte, North Carolina, USA
| | - M Austin Johnson
- Department of Emergency Medicine, University of California - Davis, Davis, California, USA
| | - David Caro
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
| | - Andy Godwin
- Department of Emergency Medicine, University of Florida, Jacksonville, Florida, USA
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Is there an impending loss of academically productive trauma surgical faculty? An analysis of 4,015 faculty. J Trauma Acute Care Surg 2017; 81:244-53. [PMID: 27257706 DOI: 10.1097/ta.0000000000001117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this work was to compare the academic impact of trauma surgery faculty relative to faculty in general surgery and other surgery subspecialties. METHODS Scholarly metrics were determined for 4,015 faculty at the top 50 National Institutes of Health (NIH)-funded university-based departments and five hospital-based surgery departments. RESULTS Overall, 317 trauma surgical faculty (8.2%) were identified. This compared to 703 other general surgical faculty (18.2%) and 2,830 other subspecialty surgical faculty (73.5%). The average size of the trauma surgical division was six faculty. Overall, 43% were assistant professors, 29% were associate professors, and 28% were full professors, while 3.1% had PhD, 2.5% had MD and PhD, and, 16.3% were division chiefs/directors. Compared with general surgery, there were no differences regarding faculty academic levels or leadership positions. Other surgical specialties had more full professors (39% vs. 28%; p < 0.05) and faculty with research degrees (PhD, 7.7%; and MD and PhD, 5.7%). Median publications/citations were lower, especially for junior trauma surgical faculty (T) compared with general surgery (G) and other (O) surgical specialties: assistant professors (T, 9 publications/76 citations vs. G, 13/138, and O, 18/241; p < 0.05), associate professors (T, 22/351 vs. G, 36/700, and O, 47/846; p < 0.05), and professors (T, 88/2,234 vs. G, 93/2193; p = NS [not significant for either publications/citations] and O, 99/2425; p = NS). Publications/Citations for division chiefs/directors were comparable with other specialties: T, 77/1,595 vs. G, 103/2,081 and O, 74/1,738; p = NS, but were lower for all nonchief faculty; T, 23/368 vs. G, 30/528 and O, 37/658; p < 0.05. Trauma surgical faculty were less likely to have current or former NIH funding than other surgical specialties (17 % vs. 27%; p < 0.05), and this included a lower rate of R01/U01/P01 funding (5.5% vs. 10.8%; p < 0.05). CONCLUSIONS Senior trauma surgical faculty are as academically productive as other general surgical faculty and other surgical specialists. Junior trauma faculty, however, publish at a lower rate than other general surgery or subspecialty faculty. Causes of decreased academic productivity and lower NIH funding must be identified, understood, and addressed.
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Hajibandeh S, Hajibandeh S. Who should lead a trauma team: Surgeon or non-surgeon? A systematic review and meta-analysis. J Inj Violence Res 2017; 9:107-116. [PMID: 28513531 PMCID: PMC5556626 DOI: 10.5249/jivr.v9i2.874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 01/24/2017] [Indexed: 11/06/2022] Open
Abstract
Background: Presence of a trauma team leader (TTL) in the trauma team is associated with positive patient outcomes in major trauma. The TTL is traditionally a surgeon who coordinates the resuscitation and ensures adherence to Advanced Trauma Life Support (ATLS) guidelines. The necessity of routine surgical leadership in the resuscitative component of trauma care has been questioned by some authors. Therefore, it remains controversial who should lead the trauma team. We aimed to evaluate outcomes associated with surgeon versus non-surgeon TTLs in management of trauma patients. Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify randomized and non-randomized studies investigating outcomes associated with surgeon versus non-surgeon TTL in management of trauma patients. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect model was applied to calculate pooled outcome data. Results: Three retrospective cohort studies, enrolling 2,519 adult major trauma patients, were included. Our analysis showed that there was no difference in survival [odds ratio (OR): 0.82, 95% confidence interval (CI) 0.61-1.10, P=0.19] and length of stay when trauma team was led by surgeon or non-surgeon TTLs; however, fewer injuries were missed when the trauma team was led by a surgeon (OR: 0.48, 95% CI 0.25-0.92, P=0.03). Conclusions: Despite constant debate, the comparative evidence about outcomes associated with surgeon and non-surgeon trauma team leader is insufficient. The best available evidence suggests that there is no significant difference in outcomes of surgeon or non-surgeon trauma team leaders. High quality randomized controlled trials are required to compare the effectiveness of surgeon and non-surgeon trauma team leaders in order to resolve the controversy about who should lead the trauma team. Clinically significant missed injuries should be considered as important outcome in future studies.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, North Manchester General Hospital, Manchester, UK.
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Hajibandeh S, Hajibandeh S. The Time Is Now to Use Clinical Outcomes as Quality Indicators for Effective Leadership in Trauma. West J Emerg Med 2017; 18:331-332. [PMID: 28435480 PMCID: PMC5391879 DOI: 10.5811/westjem.2016.12.33110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 12/30/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- Shahab Hajibandeh
- Queen's Medical Centre, General Surgery Department, Nottingham, England.,Royal Blackburn Hospital, General Surgery Department, Blackburn, England
| | - Shahin Hajibandeh
- Royal Blackburn Hospital, General Surgery Department, Blackburn, England
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Søreide K. Service as joint editor-in-chief for 11 years comes to an end: adieu, godspeed and auf wiedersehn! Scand J Trauma Resusc Emerg Med 2015; 23:110. [PMID: 26718460 PMCID: PMC4696309 DOI: 10.1186/s13049-015-0192-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 11/26/2022] Open
Affiliation(s)
- Kjetil Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, PO Box 8100, Stavanger, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Xia S, Perera T, Cowan E, Jones MP, Birnbaum A. Prehospital trauma arrival notification associated with more image studies in patients with minor head trauma discharged from ED. Am J Emerg Med 2015; 33:671-3. [DOI: 10.1016/j.ajem.2015.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 11/30/2022] Open
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Training dedicated emergency physicians in surgical critical care: knowledge acquisition and workforce collaboration for the care of critically ill trauma/surgical patients. ACTA ACUST UNITED AC 2011; 71:43-8. [PMID: 21818013 DOI: 10.1097/ta.0b013e318222f0f0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Leapfrog Group initiative has led to an increasing public demand for dedicated intensivists providing critical care services. The Acute Care Surgery training initiative promotes an expansion of trauma/surgical care and operative domain, redirecting some of our focus from critical care. Will we be able to train and enforce enough intensivists to care for critically ill surgical patients? METHODS We have been training emergency physicians (EPs) alongside surgeons in our country's largest Trauma/Surgical Critical Care Fellowship Program annually for more than a decade. We reviewed our Society of Critical Care Medicine Multidisciplinary Critical Care Knowledge Assessment Program (MCCKAP, critical care in-training examination) scores from 2006 to 2009 (4 years). The MCCKAP, administered during the ninth month of a Critical Care Fellowship, is the only known standardized objective examination available in this country to compare critical care knowledge acquisition across different specialties. Subsequent workforce outcome for these Emergency Medicine Critical Care Fellowship graduates was analyzed. RESULTS Over the 4-year period, we trained 42 Fellows in our Program who qualified for this study (30 surgeons and 12 EPs). Surgeons and EP performance scores on the MCCKAP examination were not different. The mean National Board Equivalent score was 419 ± 61 (mean ± standard deviation) for surgeons and 489 ± 87 for EPs. The highest score was achieved by an EP. The lowest score was not achieved by an EP. Ten of 12 (83%) EP Critical Care Fellowship graduates are practicing inpatient critical care in intensive care units with attending physician level responsibilities. CONCLUSIONS EPs training in a Surgical Critical Care Fellowship can acquire critical care knowledge equivalent to that of surgeons. EPs trained in a Surgical Critical Care paradigm can potentially expand the intensive care unit workforce for Surgical Critical Care patients.
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Holliman CJ, Mulligan TM, Suter RE, Cameron P, Wallis L, Anderson PD, Clem K. The efficacy and value of emergency medicine: a supportive literature review. Int J Emerg Med 2011; 4:44. [PMID: 21781295 PMCID: PMC3158547 DOI: 10.1186/1865-1380-4-44] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 07/22/2011] [Indexed: 11/10/2022] Open
Abstract
Study objectives The goal of this study was to identify publications in the medical literature that support the efficacy or value of Emergency Medicine (EM) as a medical specialty and of clinical care delivered by trained emergency physicians. In this study we use the term "value" to refer both to the "efficacy of clinical care" in terms of achieving desired patient outcomes, as well as "efficiency" in terms of effective and/or cost-effective utilization of healthcare resources in delivering emergency care. A comprehensive listing of publications describing the efficacy or value of EM has not been previously published. It is anticipated that the accumulated reference list generated by this study will serve to help promote awareness of the value of EM as a medical specialty, and acceptance and development of the specialty of EM in countries where EM is new or not yet fully established. Methods The January 1995 to October 2010 issues of selected journals, including the EM journals with the highest article impact factors, were reviewed to identify articles of studies or commentaries that evaluated efficacy, effectiveness, and/or value related to EM as a specialty or to clinical care delivered by EM practitioners. Articles were included if they found a positive or beneficial effect of EM or of EM physician-provided medical care. Additional articles that had been published prior to 1995 or in other non-EM journals already known to the authors were also included. Results A total of 282 articles were identified, and each was categorized into one of the following topics: efficacy of EM for critical care and procedures (31 articles), efficacy of EM for efficiency or cost of care (30 articles), efficacy of EM for public health or preventive medicine (34 articles), efficacy of EM for radiology (11 articles), efficacy of EM for trauma or airway management (27 articles), efficacy of EM for using ultrasound (56 articles), efficacy of EM faculty (34 articles), efficacy of EM residencies (24 articles), and overviews and editorials of EM efficacy and value (35 articles). Conclusion There is extensive medical literature that supports the efficacy and value for both EM as a medical specialty and for emergency patient care delivered by trained EM physicians.
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Affiliation(s)
- C James Holliman
- The Center for Disaster and Humanitarian Assistance Medicine, Uniformed Services University of the Health Sciences, and George Washington University School of Medicine and Health Sciences, Bethesda, MD, USA.
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