Emergent management of multisystem injuries by a general trauma surgeon

To determine the requisite education and scope of practice for a general surgeon trained to deliver emergent trauma care without the need for specialty consultation.

Retrospective case review.

Private Level I trauma center.

4097 trauma patients admitted between 1/1/92 and 30/6/97.

Mechanisms of injury; operations (total within the first 24 h) by mechanism and by surgical specialty.

Of 4097 trauma patients, 1086 (27%) underwent 1772 operative procedures within 24 h of admission, and 246 (6%) underwent 484 later operations. Orthopaedic and general surgical procedures were most common (51% of early operations). Early operations were most commonly orthopaedic for blunt trauma and general surgical for penetrating trauma. Although 685 patients (16.7%) received neurosurgical evaluation, only 150 early operations were performed (8% of the total early operations). At least 1244 procedures (55%) fell within the scope of current trauma general surgical practice advocated by some authorities.

The contribution of the various specialties to early operative trauma management is a function of the injury mechanism. As orthopaedics and neurosurgery together comprise 34% of emergency practice, a fully credentialed general surgeon with additional training in these disciplines could perform up to 90% of early operations.