In-house versus on-call trauma surgeon coverage: A systematic review and meta-analysis

Alexander C J de la Mar; Robin D Lokerman; Job F Waalwijk; Yassine Ochen; Quirine M J van der Vliet; Falco Hietbrink; R Marijn Houwert; Luke P H Leenen; Mark van Heijl

doi:10.1097/TA.0000000000003226

In-house versus on-call trauma surgeon coverage: A systematic review and meta-analysis

J Trauma Acute Care Surg. 2021 Aug 1;91(2):435-444. doi: 10.1097/TA.0000000000003226.

Authors

Alexander C J de la Mar¹, Robin D Lokerman, Job F Waalwijk, Yassine Ochen, Quirine M J van der Vliet, Falco Hietbrink, R Marijn Houwert, Luke P H Leenen, Mark van Heijl

Affiliation

¹ From the Department of Surgery (A.C.J.d.l.M., R.D.L., J.F.W., Y.O., Q.M.J.v.d.V., F.H., R.M.H., M.v.H., L.P.H.L.), University Medical Center Utrecht, Utrecht; Department of Clinical Epidemiology (Y.O.), Leiden University Medical Center, Leiden; and Department of Surgery (M.v.H.), Diakonessenhuis, Zeist, Doorn, Utrecht, the Netherlands.

PMID: 33852558
DOI: 10.1097/TA.0000000000003226

Abstract

Background: A rapid trauma response is essential to provide optimal care for severely injured patients. However, it is currently unclear if the presence of an in-house trauma surgeon affects this response during call and influences outcomes. This study compares in-hospital mortality and process-related outcomes of trauma patients treated by a 24/7 in-house versus an on-call trauma surgeon.

Methods: PubMed/Medline, Embase, and CENTRAL databases were searched on the first of November 2020. All studies comparing patients treated by a 24/7 in-house versus an on-call trauma surgeon were considered eligible for inclusion. A meta-analysis of mortality rates including all severely injured patients (i.e., Injury Severity Score of ≥16) was performed. Random-effect models were used to pool mortality rates, reported as risk ratios. The main outcome measure was in-hospital mortality. Process-related outcomes were chosen as secondary outcome measures.

Results: In total, 16 observational studies, combining 64,337 trauma patients, were included. The meta-analysis included 8 studies, comprising 7,490 severely injured patients. A significant reduction in mortality rate was found in patients treated in the 24/7 in-house trauma surgeon group compared with patients treated in the on-call trauma surgeon group (risk ratio, 0.86; 95% confidence interval, 0.78-0.95; p = 0.002; I2 = 0%). In 10 of 16 studies, at least 1 process-related outcome improved after the in-house trauma surgeon policy was implemented.

Conclusion: A 24/7 in-house trauma surgeon policy is associated with reduced mortality rates for severely injured patients treated at level I trauma centers. In addition, presence of an in-house trauma surgeon during call may improve process-related outcomes. This review recommends implementation of a 24/7 in-house attending trauma surgeon at level I trauma centers. However, the final decision on attendance policy might depend on center and region-specific conditions.

Level of evidence: Systematic review/meta-analysis, level III.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

After-Hours Care
Hospital Mortality*
Humans
Injury Severity Score
Odds Ratio
Outcome Assessment, Health Care
Personnel Staffing and Scheduling*
Surgeons*
Time Factors
Trauma Centers / standards*
Wounds and Injuries / mortality
Wounds and Injuries / surgery*