Taking the Lead – Does an Emergency Physician Led Trauma Team Impact Outcome?
July 17, 2023
Written by Michelle Skuba Gray
This large multi-center retrospective cohort study found no difference in overall risk-adjusted mortality for severely injured trauma patients treated by a surgeon versus non-surgeon trauma team leader (TTL).
Interchangeable, to a point
This study advocates that EM physicians are equally capable as surgeons to be TTL for severe traumatic injuries. This is the largest study to date with nearly 13,000 trauma activations included, performed as a retrospective cohort across multiple level 1 centers in Canada. Utilizing risk-adjustment, there was no difference in in-hospital mortality (p=0.23) . However, with a non-adjusted model there was a statistically significant difference between the two groups; postulated to be the result of significant lack of surgeons as TTL overnight (p<0.0001).
As an EM leaning journal –versus surgery based– it is easy to consider the lean towards EM trained physicians as TTL. However, with similar training in resuscitation it is not a big leap to consider the parallels in quality of care given between the two cohorts.
It is in the extreme spectrum of severity of disease, however, that perhaps this result may waiver. While the difference may be negligible in the less severely injured patients, this study is not powered to extrapolate this finding to the sickest of patients. Those patients who need interventions for hemorrhage control for example may benefit from the early presence of a trauma surgeon.
How will this change my practice?
It doesn’t necessarily change practice but supports a mixed TTL role in resource limited locations and sites. For the majority of patients, the TTL will function amicably and comparable to peers of varying specialties. There are limitations, however, and despite the trend toward non operative interventions, the sickest and most unstable of patients may still benefit from TTLs with surgical backgrounds.
Peer reviewed by Dr. Ketan Patel
Do patient outcomes differ when the trauma team leader is a surgeon or non-surgeon? A multicentre cohort study. CJEM. 2023 Jun;25(6):489-497. doi: 10.1007/s43678-023-00516-z. Epub 2023 May 15.