Surgical Management of Blunt Thoracic and Abdominal Injuries in Quebec: A Limited Volume

Bergeron, Éric; Lavoie, André; Belcaïd, Amina; Moore, Lynne; Clas, David; Razek, Tarek; Lessard, J M; Ratte, Sebastien

doi:10.1097/ta.0b013e318047b7af

Cited by 14 publications

(12 citation statements)

References 43 publications

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“…One could fear that such a low exposure, now largely depicted as part of the “future of trauma”, might jeopardize education and clinical competence and result in deteriorating performance [8,11,16,26-28]. However, a stable performance over the study period for patients with abdominal injuries was demonstrated by VLAD.…”

Section: Discussionmentioning

confidence: 99%

Abdominal injuries in a major Scandinavian trauma center – performance assessment over an 8 year period

Groven

Gaarder

Eken

et al. 2014

J Trauma Manage Outcomes

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IntroductionDamage control surgery and damage control resuscitation have reduced mortality in patients with severe abdominal injuries. The shift towards non-operative management in haemodynamically stable patients suffering blunt abdominal trauma has further contributed to the improved results. However, in many countries, low volume of trauma cases and limited exposure to trauma laparotomies constitute a threat to trauma competence. The aim of this study was to evaluate the institutional patient volume and performance for patients with abdominal injuries over an eight-year period.MethodsData from 955 consecutive trauma patients admitted in Oslo University Hospital Ulleval with abdominal injuries during the eight-year period 2002-2009 were retrospectively explored. A separate analysis was performed on all trauma patients undergoing laparotomy during the same period, whether abdominal injuries were identified or not. Variable life-adjusted display (VLAD) was used in order to describe risk-adjusted survival trends throughout the period and the patients admitted before (Period 1) and after (Period 2) the institution of a formal Trauma Service (2005) were compared.ResultsThere was a steady increase in admitted patients with abdominal injuries, while the number of patients undergoing laparotomy was constant exposing the surgical trauma team leaders to an average of 8 trauma laparotomies per year. No increase in missed injuries or failures of non-operative management was detected. Unadjusted mortality rates decreased from period 1 to period 2 for all patients with abdominal injuries as well as for the patients undergoing laparotomy. However, this apparent decrease was not confirmed as significant in TRISS-based analysis of risk-adjusted mortality. VLAD demonstrated a steady performance throughout the study period.ConclusionEven in a high volume trauma center the exposure to abdominal injuries and trauma laparotomies is limited. Due to increasing NOM, an increasing number of patients with abdominal injuries was not accompanied by an increase in number of laparotomies. However, we have demonstrated a stable performance throughout the study period as visualized by VLAD without an increase in missed injuries or failures of NOM.

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Section: Discussionmentioning

confidence: 99%

Abdominal injuries in a major Scandinavian trauma center – performance assessment over an 8 year period

Groven

Gaarder

Eken

et al. 2014

J Trauma Manage Outcomes

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“…24 However, an invasive diagnostic test (DPL), which is seldom performed, brings to attention questions of skills maintenance and diagnostic utility of seldom used laboratory indices. 19 In our study period, despite being a teaching centre and a tertiary trauma centre with a significant blunt pelvic fracture population, we performed only one DPL -hardly the clinical exposure needed for both clinicians and trainees to maintain skills in performing this test or interpreting its results.…”

Section: Discussionmentioning

confidence: 99%

“…This study period was chosen since it corresponded to institution of a new provincial trauma system ranging from a comprehensive re-organization of the EMS system to formal organization of a dedicated trauma team and trauma team leaders for the tertiary trauma centre as described elsewhere. 19 However, during the study period there was no effort nor policy to formalize the diagnostic evaluation of the study cohort of patients and all three modalities of evaluation (DPL, FAST and CT) were available to trauma team leaders and the trauma team. The province's sole adult tertiary trauma centre has a full provincial and regional trauma care mandate and dedicated 24/7 trauma team availability with dedicated trauma team leaders as described elsewhere.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Peritoneal Lavage – A Lost Art? A Retrospective Observational Study at a Canadian Tertiary Trauma Centre

Quinzio¹,

Petrie²,

Tallon³

2009

DMJ

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INTRODUCTION: Abdominal trauma is a leading cause of morbidity and mortality in the young, adult patient in North America. The standard tools to assess the severity of abdominal trauma have been evolving. The continuing role of diagnostic peritoneal lavage (DPL) as a clinical tool to evaluate intra-abdominal injury today remains controversial. This study investigated trends in the use of DPL, CT (computerized tomography) and FAST (Focused Assessment with Sonography for Trauma) in trauma patients in the province of Nova Scotia's single adult tertiary trauma centre.

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“…35 Neither is this problem unique to the UKtrainees in Australia and Canada demonstrate similar concerns. 36,37 The same issue has led to a call for re-structuring of the education of trauma surgeons in the US alongside an evolution in the way that the trauma service is provided. [38][39][40]…”

Section: Primary Amputation For Traumamentioning

confidence: 99%

Amputation and the assessment of limb viability: perceptions of two hundred and thirty two orthopaedic trainees

Eardley

Taylor

Parker

2010

annals

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Limb viability assessment is an area in which trainees feel confident and well trained. There is, however, a perceived training inadequacy in amputation surgery and a corresponding lack of confidence for many trainees, irrespective of training year. This is the first study to offer an insight into specific training experiences of junior orthopaedic surgeons at a national level and it should drive the development of opportunities for trainees to develop skills in amputation surgery.

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Surgical Management of Blunt Thoracic and Abdominal Injuries in Quebec: A Limited Volume

Cited by 14 publications

References 43 publications

Abdominal injuries in a major Scandinavian trauma center – performance assessment over an 8 year period

Abdominal injuries in a major Scandinavian trauma center – performance assessment over an 8 year period

Diagnostic Peritoneal Lavage – A Lost Art? A Retrospective Observational Study at a Canadian Tertiary Trauma Centre

Amputation and the assessment of limb viability: perceptions of two hundred and thirty two orthopaedic trainees

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