The presence of in-house attending @entity130 surgeons does not improve management or outcome of critically injured XXXX .

@entity1 @entity772 @entity580 @entity2145 @entity130
BACKGROUND: The presence of a surgeon at the initial assessment and care of the @entity130 @entity1 has been the focal point of @entity130 center designation. However, for Level I verification, the American College of Surgeons Committee on @entity130 currently does not require the presence of an attending @entity130 surgeon @entity580 ( @entity580 ), provided senior surgical residents are immediately available. Likewise, the state of Missouri does not mandate an @entity580 presence of the attending @entity130 surgeon but requires senior (postgraduate year 4 or 5) level surgical residents to immediately respond, with a 20-minute response time mandated for the attending surgeon if @entity580 or out of the hospital ( @entity2145 ). Nevertheless, some claim that @entity580 coverage by attending surgeons provides better care for seriously injured @entity1 . METHODS: This retrospective study assessed @entity1 care parameters over the past 10 years on critically injured @entity1 to detect any difference in outcome whether the surgeon was @entity580 or @entity2145 at the time of the @entity130 team activation (cardiopulmonary instability, Glasgow @entity772 Scale [GCS] score < 9, penetrating @entity130 ). @entity1 were subcategorized into blunt/penetrating, shock (systolic blood pressure < 90 mm Hg) on arrival, GCS score < 9, Injury Severity Score (ISS) > 15, or ISS > 25. Response was examined from 8 am to 6 pm weekdays ( @entity580 ) or 6 pm to 8 am weekdays and all weekends ( @entity2145 ). @entity1 care parameters examined were mortality, complications, time in the emergency department, time to the operating room, time to computed tomographic scanning, intensive care unit length of stay (LOS), and hospital LOS. RESULTS: For all @entity1 (n = 766), there was no significant difference in any parameters except intensive care unit LOS ( @entity580 , 4.90 +/- 7.96 days; @entity2145 , 3.58 +/- 7.69 days; p < 0.05). For blunt @entity130 (n = 369), emergency department time was shorter (99.71 +/- 88.26 minutes vs. 126.51 +/- 96.68 minutes, p < 0.01) and hospital LOS was shorter (8.04 +/- 1.02 days vs. 11.08 +/- 1.15 days, p < 0.05) for @entity2145 response. For penetrating @entity130 (n = 377), shock (n = 187), GCS score < 9 (n = 248), ISS > 15 (n = 363), and ISS > 25 (n = 230), there were no statistically significant differences in any @entity1 care parameter between @entity580 and @entity2145 response. For those in most need of urgent operation-penetrating injuries and shock-there were no differences in time to operating room or mortality for @entity2145 or @entity580 response. CONCLUSION: As long as initial assessment and care is provided by senior level @entity580 surgical residents and as long as the attending surgeon responds in a defined period of time (if @entity2145 ) to guide critical decision-making, the @entity580 presence of an attending surgeon has not been shown in this retrospective study to improve care of the critically injured @entity1 .
