Associate Professor University of Texas Health Sciences Center at Houston Houston, Texas, United States
Introduction: “July effect” refers to the assumption that the complication rate is higher and the survival rate is less for patients cared for at academic intuitions in July when students and residents transition up the training hierarchy.
Methods: We performed a multicenter, retrospective cohort study between 2010 and 2020 with trauma registry data from the University of Texas at Houston, University of Louisville, University of Pittsburgh, Tulane University, and the University of Miami. Data were collected from a single mechanism of injury, motor vehicle collisions (MVCs), and included date and time of injury, injury severity score (ISS), and mortality. Each injury was classified as minor (ISS 1–8), moderate (9-15), severe (16-24), and very severe (>25). The mortality for each range over the entire epoch was calculated by month for these four ISS bands. 95% confidence intervals were computed using bootstrapping (resampling without replacement 10,000 times for each center).
Results: We analyzed 39,668 MVC traumas (mean age ranged from 39.9-43.3 among sites, 56.1-61.2% male). Survival for the “very severe” traumas ranged from 79.6-90.3%. Across the five sites, there was no significant change in survival (either increase or decreased mortality) of MVC patients in July or August. Survival below baseline was noted in only one site during September and October but was not significant when accounting for false detection rate. Additionally, there was no significant increase in length of stay during July or August.
Conclusion : In five high-volume, level 1 trauma centers, there was no clear effect of the July/August transition on survival of MVC trauma patients.
