Bergeron Eric, Lavoie Andre, Razek Tarek, Belcaid Amina, Lessard Julie, Clas David
Traumatology Department, Hôpital Charles-LeMoyne, Greenfield Park, Montréal, Québec.
Can J Surg. 2005 Aug;48(4):284-8.
The frequency of penetrating trauma is low in Canada. Current recommendations for the care of patients with penetrating injuries originate from inner city trauma centres with a high volume of such injuries and may not apply to Canada. The purpose of this study was to review the incidence and treatment of penetrating thoracoabdominal injuries in the 4 tertiary trauma centres in Quebec.
We identified all patients with penetrating thoracic or abdominal injuries who were taken to any of the 4 tertiary trauma centres in the province of Quebec between Apr. 1, 1998, and Mar. 31, 2001. Patients who were dead on arrival were excluded. Only patients with an Abbreviated Injury Scale of 2 or greater for the thoracic or abdominal regions were included.
In total, 245 patients meeting our inclusion criteria were identified. Of these 223 (91%) were male. The mean (and standard deviation) age was 33.8 (13.2) years; range 15-90 years. The median Injury Severity Score was 10 (range 4-75). Overall in-hospital mortality was 6.9%. There were 203 patients (82.8%) with thoracic injuries and 192 patients (78.4%) with abdominal injuries. Fifty (20.4%) of these patients had injuries to both regions. A thoracotomy was carried out in 48 (31.4%) of 153 patients who had injuries to the thorax, and the abdomen was explored in 133 (93.7%) of the 142 patients with abdominal injuries. The incidence of these injuries in the study period varied from 3 to 49 cases per centre.
The annual incidence of penetrating thoracoabdominal injuries is extremely low in all 4 of Quebec's tertiary trauma centres, and the number of thoracoabdominal procedures is even lower. Such a low exposure may jeopardize education and clinical competence. We need to rethink our educational strategies both for residents and for continuing medical education. New approaches to training and maintenance of competence must be developed.
在加拿大，穿透性创伤的发生率较低。目前针对穿透伤患者的护理建议源自那些此类损伤数量众多的市中心创伤中心，可能并不适用于加拿大。本研究的目的是回顾魁北克省4家三级创伤中心穿透性胸腹伤的发病率及治疗情况。
我们确定了1998年4月1日至2001年3月31日期间被送往魁北克省4家三级创伤中心中任何一家的所有穿透性胸伤或腹伤患者。入院时已死亡的患者被排除。仅纳入胸腹部区域简明损伤定级为2级或更高的患者。
总共确定了245名符合我们纳入标准的患者。其中223名（91%）为男性。平均（及标准差）年龄为33.8（13.2）岁；年龄范围为15至90岁。损伤严重度评分中位数为10（范围为4至75）。总体院内死亡率为6.9%。有203名患者（82.8%）有胸伤，192名患者（78.4%）有腹伤。其中50名（20.4%）患者两个区域均有损伤。在153名有胸伤的患者中，48名（31.4%）接受了开胸手术，在142名有腹伤的患者中，133名（93.7%）接受了腹部探查。在研究期间，这些损伤在各中心的发病率从3例至49例不等。
在魁北克省所有4家三级创伤中心，穿透性胸腹伤的年发病率极低，胸腹联合手术的数量更低。如此低的病例接触量可能会影响教育及临床能力。我们需要重新思考针对住院医师及继续医学教育的教育策略。必须制定新的培训及能力维持方法。
