We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Critique |

Surgeon- and System-Based Influences on Trauma Mortality—Invited Critique

David V. Feliciano, MD
Arch Surg. 2009;144(8):764-765. doi:10.1001/archsurg.2009.93.
Text Size: A A A
Published online


Haut et al are to be congratulated for a comprehensive analysis of the changes that occurred in their trauma center after the introduction of new leadership and structure in 1998. The experience of the in-house trauma attending surgeon did not have an effect on overall patient mortality, whereas the change in leadership and structure decreased mortality when novice surgeons were the caregivers. The use of mortality as an end point in analyzing trauma care does have some limitations. For example, it would be helpful to know the actual percentages of blunt vs gunshot wound vs stab wound mechanisms of injury in all groups. Patients with hypotension in the former 2 groups have significant mortality compared with the latter group when the admission base deficit exceeds −15. It would be expected that the greatest advantage of having an experienced surgeon available would be in the performance of index abdominal trauma operations, that is, those involving repair of complex injuries to the liver, pancreaticoduodenal complex, and major abdominal vascular structures. The ISS simply does not differentiate between magnitudes of abdominal injuries in patients with penetrating trauma. In addition, no information is given about the number of preventable or potentially preventable deaths when comparing novice surgeons with the senior surgeon. If 10% to 15% of the deaths in the patients cared for by novice surgeons were in these categories compared with 1% to 2% for the senior surgeon, the entire analysis using mortality as an end point would be in question.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Hemodynamically Stable Patients

The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Accuracy of Individual Findings From the Clinical History and Physical Examination