Fakhry Samir M, Watts Dorraine D, Michetti Christopher, Hunt John P
Inova Regional Trauma Center, Inova Fairfax Hospital, Falls Church, Virginia 22042, USA.
J Trauma. 2003 Jan;54(1):1-7; discussion 7-8. doi: 10.1097/00005373-200301000-00001.
The surgical resident experience with trauma has changed. Many residents are exposed to predominantly nonoperative patient care experiences while on trauma rotations. Data from a large multicenter study were analyzed to estimate surgical resident exposure to trauma laparotomy, diagnostic peritoneal lavage (DPL), and focused abdominal sonography for trauma (U/S).
Centers completed a self-report questionnaire on their institutional demographics, admissions, and procedure for a 2-year period (1998-1999).
A total of 82 trauma centers that provide resident teaching were included. The included centers represent over 247,000 trauma admissions. The majority of trauma centers (65.9%) had > 80% blunt injury. Although all centers performed laparotomies, other results were more variable. For U/S, 24.2% performed none at all and 47.0% performed fewer than two U/S examinations per month. For DPLs, 3.8% performed none and 66.7% performed fewer than two per month. Assuming 1 night of 4 on call, the average surgical resident training at a trauma center performing > 80% blunt trauma has the potential to participate in only 15 trauma laparotomies, 6 diagnostic peritoneal lavages, and 45 ultrasound examinations per year. In addition, the resident will care for an average of 500 blunt trauma patients before performing a splenectomy or liver repair.
Surgical resident experience on most trauma services is heavily weighted to nonoperative management, with a relatively low number of procedures, little experience with DPL, and highly variable experience with ultrasound. These data have serious implications for resident training and recruitment into the specialty.
外科住院医师的创伤治疗经历已发生变化。许多住院医师在创伤轮转期间主要接触非手术患者护理经验。分析了一项大型多中心研究的数据，以估计外科住院医师进行创伤剖腹手术、诊断性腹腔灌洗（DPL）和创伤重点腹部超声检查（U/S）的情况。
各中心填写了一份关于其机构人口统计学、入院情况及为期2年（1998 - 1999年）的手术程序的自我报告问卷。
共纳入了82个提供住院医师教学的创伤中心。这些中心代表了超过24.7万例创伤入院病例。大多数创伤中心（65.9%）钝性损伤患者比例超过80%。虽然所有中心都进行剖腹手术，但其他结果差异更大。对于超声检查，24.2%的中心根本不进行，47.0%的中心每月进行少于两次超声检查。对于DPL，3.8%的中心不进行，66.7%的中心每月进行少于两次。假设4人值班1晚，在钝性创伤患者比例超过80%的创伤中心，外科住院医师平均每年可能仅参与15例创伤剖腹手术、6次诊断性腹腔灌洗和45次超声检查。此外，住院医师在进行脾切除术或肝脏修复之前，平均将护理500例钝性创伤患者。
大多数创伤服务中外科住院医师的经历严重倾向于非手术管理，手术数量相对较少，DPL经验不足，超声检查经验差异很大。这些数据对住院医师培训和该专业的人才招募具有严重影响。
