Extending surgeon response times in tier 2 traumas does not adversely affect patient outcomes

• Published in: The Journal of surgical research 2018-06, Vol.226, p.24-30
• Main Authors: Zimmerman, Steven Anthony, Reed, Christopher S., Reed, Alexander N., Jones, Ronald J., Chard, Annette, Reed, Donald N.
• Format: Article
• Language: English
• Subjects: Golden hour; Mortality; Patient outcome assessment; Response times; Surgeons; Trauma
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2017.12.037

The presence of a trauma surgeon during patient resuscitations is required at most American College of Surgeons–verified trauma centers despite little evidence showing improved patient outcomes in the less-than-critically injured (Tier 2) trauma patients. This study was designed to identify the impact of extending required surgeon response times on outcomes in tier 2 trauma patients. An American College of Surgeons–verified level 2 trauma center extended the maximum allowed surgeon response time for tier 2 activations from 60 min to 120 min on November 1, 2011. Surgeon response time and patient outcomes of the retrospective control group (January 1, 2008-October 31, 2011) were then compared with the prospective test group (November 1, 2011-December 31, 2014). Primary outcomes included mortality and hospital length of stay (HLOS). Secondary outcomes were emergency department length of stay, and time from ED arrival to CT scan. A subset analysis of all patients evaluated by a surgeon within 60 min of arrival versus those evaluated by a surgeon after 60 min was also performed. The control and test groups were composed of 757 and 792 patients, and their mean injury severity score was 9.0 and 6.0, respectively. Emergency department length of stay showed a statistically significant increase of 12 min, whereas HLOS was unchanged throughout the study. Mortality was not significantly different between the groups. Subset analysis revealed a median surgeon arrival time of 15 min in the 60-min group, whereas the injury severity score, HLOS, and mortality were not significantly different between these subsets. No correlation existed between these outcomes and surgeon arrival time. Doubling required surgeon response time in tier 2 trauma patients does not produce negative outcomes in this patient group. Mandatory surgeon response times in similar patient groups can be re-evaluated to allow for greater flexibility of a limited surgeon workforce while still providing safe care.