Abstract
:Background:Presence of a trauma team leader (TTL) in the trauma team is associated with positive patient outcomes in major trauma. The TTL is traditionally a surgeon who coordinates the resuscitation and ensures adherence to Advanced Trauma Life Support (ATLS) guidelines. The necessity of routine surgical leadership in the resuscitative component of trauma care has been questioned by some authors. Therefore, it remains controversial who should lead the trauma team. We aimed to evaluate outcomes associated with surgeon versus non-surgeon TTLs in management of trauma patients.Methods:In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement standards, we performed a systematic review. Electronic databases MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched to identify randomized and non-randomized studies investigating outcomes associated with surgeon versus non-surgeon TTL in management of trauma patients. The Newcastle-Ottawa scale was used to assess the methodological quality and risk of bias of the selected studies. Fixed-effect model was applied to calculate pooled outcome data.Results:Three retrospective cohort studies, enrolling 2,519 adult major trauma patients, were included. Our analysis showed that there was no difference in survival [odds ratio (OR): 0.82, 95% confidence interval (CI) 0.61-1.10, P=0.19] and length of stay when trauma team was led by surgeon or non-surgeon TTLs; however, fewer injuries were missed when the trauma team was led by a surgeon (OR: 0.48, 95% CI 0.25-0.92, P=0.03).Conclusions:Despite constant debate, the comparative evidence about outcomes associated with surgeon and non-surgeon trauma team leader is insufficient. The best available evidence suggests that there is no significant difference in outcomes of surgeon or non-surgeon trauma team leaders. High quality randomized controlled trials are required to compare the effectiveness of surgeon and non-surgeon trauma team leaders in order to resolve the controversy about who should lead the trauma team. Clinically significant missed injuries should be considered as important outcome in future studies.
Highlights
Trauma is a leading cause of death and disability worldwide.[1]
Our analysis showed that there was no difference in survival [odds ratio (OR): 0.82, 95% confidence interval (CI) 0.61-1.10, P=0.19] and length of stay when trauma team was led by surgeon or non-surgeon trauma team leader (TTL); fewer injuries were missed when the trauma team was led by a surgeon (OR: 0.48, 95% CI 0.25-0.92, P=0.03)
Despite constant debate, the comparative evidence about outcomes associated with surgeon and non-surgeon trauma team leader is insufficient
Summary
Trauma is a leading cause of death and disability worldwide.[1] The introduction of trauma teams has improved outcomes of the initial assessment and resuscitation of trauma patients.[2, 3] A trauma team is a multidisciplinary team consisting of a group of individuals from various specialties including anesthesia, emergency medicine, surgery, nursing and support staff. Presence of a trauma team leader (TTL) in the trauma team is associated with positive patient outcomes in major trauma.[2, 4] A TTL should be familiar with trauma triage, be aware of trauma care protocol, be exposed to evidence-based studies, be adept to kinematics of various injuries, be able to execute multiple tasks of trauma resuscitation, be capable to diagnose cases that need immediate surgical interventions, and be skilled in various routine and critical care issues. A TTL should provide complete, coordinated and efficient care and enhance the entire trauma system through a variety of activities, including education, secondary injury prevention and control, and injury surveillance.[5]
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