TY  - JOUR
T1  - INfluence of resident involvement on trauma care outcomes
AU  - Bukur M, Singer MB, Chung R, et al
Y1  - 2012/09/01
N1  - 10.1001/archsurg.2012.1672
JO  - Archives of Surgery
SP  - 856
EP  - 862
VL  - 147
IS  - 9
N2  - Hypothesis 
                  Discrepancies exist in complications and outcomes at teaching trauma centers (TTCs) vs nonteaching TCs (NTCs).Design 
                  Retrospective review of the National Trauma Data Bank research data sets (January 1, 2007, through December 31, 2008).Setting 
                  Level II TCs.Patients 
                  Patients at TTCs were compared with patients at NTCs using demographic, clinical, and outcome data. Regression modeling was used to adjust for confounding factors to determine the effect of house staff presence on failure to rescue, defined as mortality after an in-house complication.Main Outcome Measures 
                  The primary outcome measures were major complications, in-hospital mortality, and failure to rescue.Results 
                  In total, 162 687 patients were available for analysis, 36 713 of whom (22.6%) were admitted to NTCs. Compared with patients admitted to TTCs, patients admitted to NTCs were older (52.8 vs 50.7 years), had more severe head injuries (8.3% vs 7.8%), and were more likely to undergo immediate operation (15.0% vs 13.2%) or ICU admission (28.1% vs 22.8%) (P < .01 for all). The mean Injury Severity Scores were similar between the groups (10.1 for patients admitted to NTCs vs 10.4 for patients admitted to TTCs, P < .01). Compared with patients admitted to TTCs, patients admitted to NTCs experienced fewer complications (adjusted odds ratio [aOR], 0.63; P < .01), had a lower adjusted mortality rate (aOR, 0.87; P = .01), and were less likely to experience failure to rescue (aOR, 0.81; P = .01).Conclusions 
                  Admission to level II TTCs is associated with an increased risk for major complications and a higher rate of failure to rescue compared with admission to level II NTCs. Further investigation of the differences in care provided by level II TTCs vs NTCs may identify areas for improvement in residency training and processes of care.
SN  - 0004-0010
M3  - doi: 10.1001/archsurg.2012.1672
UR  - http://dx.doi.org/10.1001/archsurg.2012.1672
ER  -