As surgeons, we know trauma. We easily bring to mind commonly accepted examples: the 2-car pileup with multiple fatalities, the fall off a ladder, and the gunshot wound to the abdomen. We see people bloody, bruised, and broken every day and we come to believe that trauma surgeons care for patients only on those patients' most dramatic and clearly life-threatening days. Unfortunately, for many patients, this does not tell the whole story.Exposure to multiple traumatic events across the life span is regrettably common. Approximately 2 in 3 children experience trauma or chronic stress, and almost 90% of adults experience at least 1 traumatic exposure, as defined by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5), in their lifetime. 1 These negative experiences collectively elevate a patient's risk for long-term health conditions and subsequent trauma recidivism. [2][3][4] These data highlight 2 central questions. Do we who provide medical care truly understand how various types of trauma may affect a patient? And if not, can we genuinely deliver optimal care?Part of this discrepancy is, arguably, how we define trauma. Among Merriam-Webster's definitions of trauma is "an injury to living tissue…caused by an extrinsic agent," which certainly captures the essence of the physical injury one observes in the trauma bay. However, the Substance Abuse and Mental Health Services Administration (SAMHSA) expands the definition of trauma to include any event or circumstance that an individual (or group) experiences that can increase the risk for physical or psychological harm. 5 The SAMHSA definition of trauma is compelling and pulls us away from our concrete logic. Trauma is not only physical injury but also emotional and psychological harm. More important, trauma does not have to be a discrete event but can include a state of being-such as homelessness, neglect, or poverty-that has the potential for future harm. Primary care, psychiatry, and pediatrics have begun to incorporate this broadened definition of trauma into the care of patients, but surgery too must shift toward trauma-informed care for maximum benefit to patients.Although the concept of trauma-informed care may be novel to surgeons, it evolved out of a public health approach that considers antecedents of disease and behavior. Taken from the socioecological framework, a patient has individual, community, and societal factors that collectively increase or decrease the risk for poor health and injury.
