Involvement of surgical residents in the management of trauma patients in the emergency room: does the presence of an attending physician affect outcomes?

Abstract

Few studies have investigated whether the presence or absence of attending physicians (AP) in the emergency department (ED) during the management of trauma patients by residents. Six level 1 trauma center admissions for years 2006-2008 were analyzed to determine whether presence of an AP affected the time spent in the ED, post-ED disposition, and in-hospital mortality. Patient demographics differed in relation to the presence of APs (P < 0.01). Patients with ISS > 25 who died during hospitalization were more often managed when APs were present. Male patients, those <65, and patients with Injury Severity Score (ISS) > 16 were more often treated in the presence of an AP (P < 0.01). Penetrating, terror trauma, motor vehicle collision and assaults were more often managed in the presence APs. Presence of APs differed by hospital (P < 0.0001). Adjusted logistic regression revealed that patients spent less time in the ED, went directly to the operating room or the ICU for definitive care, if an AP was present. Presence of an attending physician improved and focused patient triage, disposition decisions, and outcomes.