In-house versus on-call attending trauma surgeons at comparable level I trauma centers: A prospective study

Background: The purpose of this study was to prospectively compare patient outcomes based on the presence of in-house versus on-call attending trauma surgeons at comparable Level I trauma centers. Methods: Two designated Level I trauma centers agreed to prospectively revi ew trauma admissions over a 6-month period, one institution with 24-hour in -house trauma attending surgeons (IH), and the other with trauma-attending surgeons taking call from home (OC) available to the hospital within 15 min utes of notification. A 6-month prospective study was conducted reviewing a ll trauma patients admitted to both trauma centers with an Injury Severity Score greater than or equal to 16. Comparisons were made between institutio ns utilizing admission demographics, clinical presentation, times to clinic al care, and mortality rates, Results: In comparison, OC and IH institutions were distinctly different in geographic environment, size, and number of patients admitted. As a group, IH patients were significantly older, with higher Injury Severity Scores a nd lower Glasgow Coma Scale scores than the OC group. In all comparisons, O C trauma attending surgeons responded to the trauma room with equal speed o r more rapidly when compared with IH trauma attending surgeons. There were no other significant differences in either population in times to provision of clinical care or in clinical outcome, Conclusion: The ability of the OC institution to be similar to the IH insti tution in its provision of clinical care and mortality rate is accomplished in an environment where trauma attending surgeons live within a Ii-minute response time to the trauma center. Using a voice-paged trauma alert activa tion with accurate information and sufficient warning, evaluation, provisio n of care, and clinical outcome of the acutely injured patient can be provi ded equally by in-house trauma attending surgeons and trauma attending surg eons on-call from home.