[How many generalists and how many specialists does orthopedics and traumatology need?]

Trauma Team Activation: Which Surgical Capability Is Immediately Required in Polytrauma? A Retrospective, Monocentric Analysis of Emergency Procedures Performed on 751 Severely Injured Patients

There has been an ongoing discussion as to which interventions should be carried out by an “organ specialist” (for example, a thoracic or visceral surgeon) or by a trauma surgeon with appropriate general surgical training in polytrauma patients. However, there are only limited data about which exact emergency interventions are immediately carried out. This retrospective data analysis of one Level 1 trauma center includes adult polytrauma patients, as defined according to the Berlin definition. The primary outcome was the four most common emergency surgical interventions (ESI) performed during primary resuscitation. Out of 1116 patients, 751 (67.3%) patients (male gender, 530, 74.3%) met the inclusion criteria. The median age was 39 years (IQR: 25, 58) and the median injury severity score (ISS) was 38 (IQR: 29, 45). In total, 711 (94.7%) patients had at least one ESI. The four most common ESI were the insertion of a chest tube (48%), emergency laparotomy (26.3%), external fixation (23.5%), and the insertion of an intracranial pressure probe (ICP) (19.3%). The initial emergency treatment of polytrauma patients include a limited spectrum of potential life-saving interventions across distinct body regions. Polytrauma care would benefit from the 24/7 availability of a trauma team able to perform basic potentially life-saving surgical interventions, including chest tube insertion, emergency laparotomy, placing external fixators, and ICP insertion.

Survey on structural preparedness for treatment of thoracic and abdominal trauma in German-speaking level 1 trauma centers

INTRODUCTION

Increasing sub-specialization has reduced the number of general surgeons involved in the care of trauma patients in German-speaking countries (Germany, Austria and Switzerland) over the past decades. Thus, the aim of this study was to assess, to what extent level 1 trauma centers are still prepared to provide immediate emergency surgery in patients with thoracic or abdominal trauma.

METHODS

Web-based and paper questionnaires were sent to all level 1 trauma centers participating in the TraumaRegister DGU® (TR-DGU) in Germany, Austria, and Switzerland from Feb 2017 to Sep 2017. The centers were asked about the presence or availability of surgeons who were able to perform an emergency laparotomy or thoracotomy.

RESULTS

Of all 117 level 1 trauma centers participating in the TR-DGU in Germany, Austria, and Switzerland, 97 (83%) gave a response. A board-certified surgeon who is able to perform an emergency laparotomy is present 24 h/7 days a week in 72% of the centers (emergency thoracotomy: 57%). In centers where no such surgeon was present the whole time, the mean maximum time of arrival of the surgeon on call was 18.9 min (SD 7.0, range 10-40 min) regarding the ability to perform an emergency laparotomy and 19.9 min (SD 7.0, range 10-40 min) regarding the emergency thoracotomy.

CONCLUSION

The majority of level 1 trauma centers in Germany, Switzerland, and Austria in the TR-DGU seem to be well prepared to treat severe injuries of the abdominal and thoracic cavities. In some centers, however, a surgeon able to perform an emergency laparotomy or thoracotomy is not available within 30 min.