Editor’s Capsule Summary
What is already known on this topic
Trauma centers improve the outcomes for victims of trauma. Many trauma systems require a trauma surgeon be present for patient arrival, despite a lack of evidence that this component of the system improves patient outcome.
What question this study addressed
This study addressed whether a clinical decision rule could be derived that predicted when a trauma patient would require emergency operative intervention within 1 hour of arrival.
What this study adds to our knowledge
In adult patients, patients with a penetrating injury, systolic blood pressure less than 96 mm Hg, or a pulse rate greater than 104 beats/min had a 97% sensitivity and 49% specificity for predicting need for emergency operative intervention. Not having surgeons present at arrival for patients without any of these criteria could reduce surgeon calls by 51% while failing to identify only 0.08% of adult patients requiring emergency operative intervention. For children, never having a surgeon present at arrival would fail to identify emergency operative intervention in only 0.35% of cases.
How this might change clinical practice
Use of a clinical decision rule to reduce the number of resources necessary to meet a major trauma patient might improve resource allocation. A validation study is needed to establish that the numbers presented here can be realized in actual practice.