Background: Trauma centers have historically been staffed by attending surgeons and varying levels of surgery and emergency residents. With the imposition of resident work hour restrictions there was a need for staffing solutions. One of the options that has been utilized is the addition or replacement of residents by physician assistants (PAs). What is the impact of PAs on the outcomes of trauma patients at level I centers when compared with resident only teams?
Methods: An exhaustive search of available medical literature was conducted using Medline-OVID, CINAHL, and Web of Science. The keywords used for each search were: physician assistant, trauma center, length of stay, patient readmission, and hospital mortality. Additional inclusion and exclusion criteria were used to focus the search.
Results: Three retrospective studies met criteria and were included and assessed for this systematic review. One study compared a resident based team with a team that added PAs and found no change in mortality rates and a reduction in length of stay (LOS). Another study compared three groups: a resident based team, an attending surgeon only team, and a PA based team. This study showed a reduction in mortality and LOS. A third study compared a PA based team with the National Trauma Data Bank. That study showed a reduction in mortality and LOS when normalizing for injury severity.
Conclusion: When PAs were added to or replaced residents on trauma teams there was either no change or a reduction in patient mortality and length of stay. PAs can be a helpful and productive addition or replacement on resident based teams without negatively impacting patient outcomes.
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