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Invited Critique |

Reduced Mortality at a Community Hospital Trauma Center—Invited Critique

Elliott R. Haut, MD
Arch Surg. 2008;143(1):27-28. doi:10.1001/archsurg.2007.2-a.
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Scientific evidence is accumulating, supporting the long-held belief that trauma centers save lives.1 Scarborough and colleagues add to this literature with compelling data that injured patients admitted to SMC had improved mortality in the 4¼-year period beginning January 1, 2003, vs the previous 5-year period.

The authors suggest that this improved mortality was entirely because of the change in trauma level designation, although the exact mechanism by which this improvement occurred is not clear. Other interpretations are also plausible. Could this be the effect of a staffing change that produced a “core group of dedicated trauma surgeons” treating all trauma patients as opposed to on-call general surgeons? It has been suggested that “full-time” trauma surgeons achieve improved survival compared with general surgeons who cover trauma “part-time.”2 Is it merely a volume-outcome relationship with improved outcomes from trauma surgeons treating more patients?3,4 Was it because of the 24-hour in-house trauma attending surgeon coverage?5,6 Could it be the positive effect of being a teaching institution?7

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