The "July Phenomenon"

Is Trauma the Exception?

Thomas J. Schroeppel, Peter Fischer, Louis J. Magnotti, Martin Croce, Timothy Fabian

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: The concept of increased medical errors in July, secondary to new residents (the "July phenomenon"), often receives considerable attention without supporting evidence. A recent study reported a 41% increase in mortality during July and August in general surgery patients. The objective of this study was to determine if a July phenomenon existed in a Level I trauma center with an attending present at all times. Study Design: A retrospective cohort study was conducted at an academic, tertiary Level I trauma center. Blunt trauma patients admitted during a 5-year period were compared for differences in outcomes by month and quarter. Chi-square and analysis of variance were used for categorical and continuous variables where appropriate. Linear regression was used to examine the effect of month on ventilator support days, ICU days, and minutes in the resuscitation room. Multivariable linear regression was used to examine the effect of month and quarter on mortality. Results: A total of 12,525 patients were analyzed by month and 14,798 patients were analyzed by quarter. Overall, 68% were men and 32% women, with a mean age of 39.5 years. Mean Injury Severity Score was 12.4. Mean 24-hour transfusion requirement was 0.5 U. Mean emergency department Glasgow Coma Scale score was 14. Multivariable logistic regression failed to show month or quarter of the year to be an independent predictor of mortality after adjusting for age, Injury Severity Score, emergency department Glasgow Coma Scale score, and 24-hour transfusion requirement (c = 0.97). Linear regression failed to show any monthly variation on ventilator-support days, ICU days, or minutes in the resuscitation room. Conclusions: The July phenomenon does not exist at this Level I trauma center with in-hospital attending supervision.

Original languageEnglish (US)
Pages (from-to)378-384
Number of pages7
JournalJournal of the American College of Surgeons
Volume209
Issue number3
DOIs
StatePublished - Sep 1 2009

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Trauma Centers
Linear Models
Glasgow Coma Scale
Injury Severity Score
Wounds and Injuries
Mechanical Ventilators
Resuscitation
Mortality
Hospital Emergency Service
Medical Errors
Analysis of Variance
Cohort Studies
Retrospective Studies
Logistic Models

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

The "July Phenomenon" : Is Trauma the Exception? / Schroeppel, Thomas J.; Fischer, Peter; Magnotti, Louis J.; Croce, Martin; Fabian, Timothy.

In: Journal of the American College of Surgeons, Vol. 209, No. 3, 01.09.2009, p. 378-384.

Research output: Contribution to journalArticle

Schroeppel, Thomas J. ; Fischer, Peter ; Magnotti, Louis J. ; Croce, Martin ; Fabian, Timothy. / The "July Phenomenon" : Is Trauma the Exception?. In: Journal of the American College of Surgeons. 2009 ; Vol. 209, No. 3. pp. 378-384.
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