Abstract
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.
Highlights
Trauma is among the leading causes of morbidity and mortality in the working population [1]
Whether thoracoabdominal interventions should be performed by an “organ specialist” who is present in the resuscitation area, or by a trauma surgeon with the appropriate general surgical training and the skills required for damage control surgery [13]
The utilized database contains the records of 3663 patients, with 1116 (30.5%) patients meeting the Berlin definition of polytrauma
Summary
Trauma is among the leading causes of morbidity and mortality in the working population [1]. Selected institutions have the luxury of activating an interdisciplinary trauma team, including an anesthesiologist, radiologist, neurosurgeon, and a trauma surgeon with surgical competences of the whole body [7]. There has been an ongoing discussion, especially in German speaking countries, as to which level of thoracoabdominal interventions a general surgeon is capable of providing as primary care to polytrauma patients, especially due to changes in the training of medical specialists [11,12]. Whether thoracoabdominal interventions should be performed by an “organ specialist” (for example, a thoracic or visceral surgeon) who is present in the resuscitation area, or by a trauma surgeon with the appropriate general surgical training and the skills required for damage control surgery [13]. The principle of interdisciplinary collaboration under the direction of a general trauma surgeon is currently the basis of major trauma centers [14]
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