Influence of resident involvement on trauma care outcomes

Marko Bukur, Matthew B. Singer, Rex Chung, Eric J. Ley, Darren Malinoski, Daniel R. Margulies, Ali Salim

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Hypothesis: Discrepancies exist in complications and outcomes at teaching trauma centers (TTCs) vs nonteaching. TCs (NTCs). Design: Retrospective review of the National Trauma Data Bank research data sets (January 1, 2007, through December 31, 2008). Setting: Level II TCs. Patients: Patients at TTCs were compared with patients at NTCs using demographic, clinical, and outcome data. Regression modeling was used to adjust for confounding factors to determine the effect of house staff presence on failure to rescue, defined as mortality after an in-house complication. Main Outcome Measures: The primary outcome measures were major complications, in-hospital mortality, and failure to rescue. Results: In total, 162 687 patients were available for analysis, 36 713 ofwhom(22.6%) were admitted to NTCs. Compared with patients admitted to TTCs, patients admitted to NTCs were older (52.8 vs 50.7 years), had more severe head injuries (8.3% vs 7.8%), and were more likely to undergo immediate operation (15.0% vs 13.2%) or ICU admission (28.1% vs 22.8%) (P>.01 for all). The mean Injury Severity Scores were similar between the groups (10.1 for patients admitted to NTCs vs 10.4 for patients admitted to TTCs, P>.01). Compared with patients admitted to TTCs, patients admitted to NTCs experienced fewer complications (adjusted odds ratio [aOR], 0.63; P>.01), had a lower adjusted mortality rate (aOR, 0.87; P=.01), and were less likely to experience failure to rescue (aOR, 0.81; P=.01). Conclusions: Admission to level II TTCs is associated with an increased risk for major complications and a higher rate of failure to rescue compared with admission to level II NTCs. Further investigation of the differences in care provided by level II TTCs vs NTCs may identify areas for improvement in residency training and processes of care.

Original languageEnglish (US)
Pages (from-to)856-862
Number of pages7
JournalArchives of Surgery
Volume147
Issue number9
DOIs
StatePublished - Sep 2012
Externally publishedYes

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Trauma Centers
Teaching
Wounds and Injuries
Odds Ratio
Internship and Residency
Hospital Mortality
Outcome Assessment (Health Care)
Injury Severity Score
Craniocerebral Trauma
Demography
Databases
Mortality
Research

ASJC Scopus subject areas

  • Surgery

Cite this

Bukur, M., Singer, M. B., Chung, R., Ley, E. J., Malinoski, D., Margulies, D. R., & Salim, A. (2012). Influence of resident involvement on trauma care outcomes. Archives of Surgery, 147(9), 856-862. https://doi.org/10.1001/archsurg.2012.1672

Influence of resident involvement on trauma care outcomes. / Bukur, Marko; Singer, Matthew B.; Chung, Rex; Ley, Eric J.; Malinoski, Darren; Margulies, Daniel R.; Salim, Ali.

In: Archives of Surgery, Vol. 147, No. 9, 09.2012, p. 856-862.

Research output: Contribution to journalArticle

Bukur, M, Singer, MB, Chung, R, Ley, EJ, Malinoski, D, Margulies, DR & Salim, A 2012, 'Influence of resident involvement on trauma care outcomes', Archives of Surgery, vol. 147, no. 9, pp. 856-862. https://doi.org/10.1001/archsurg.2012.1672
Bukur, Marko ; Singer, Matthew B. ; Chung, Rex ; Ley, Eric J. ; Malinoski, Darren ; Margulies, Daniel R. ; Salim, Ali. / Influence of resident involvement on trauma care outcomes. In: Archives of Surgery. 2012 ; Vol. 147, No. 9. pp. 856-862.
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