Cothren C Clay, Moore Ernest E, Hoyt David B
Department of Surgery, Denver Health Medical Center and the University of Colorado School of Medicine, Denver, Colorado, USA.
J Trauma. 2008 Apr;64(4):955-65; discussion 965-8. doi: 10.1097/TA.0b013e3181692148.
The evolving discipline of acute care surgery as an expansion of trauma surgery is undergoing intense critique. As we envision this new paradigm of surgical practice, an evaluation of our current status across the nation's trauma centers is an essential step. The purpose of this study is to determine the practice patterns of trauma surgeons at major trauma centers throughout the United States.
A survey was sent to the trauma directors of the 1,288 designated trauma centers in the United States, as listed by the American Trauma Society. As proposed, acute care surgery would encompass performing emergent abdominal, vascular, and thoracic trauma procedures as well as providing critical care. The addition of simple orthopedic and neurosurgical procedures has been considered.
The survey response rate was 72% among the Level I/II/III centers (n = 515) with 92% of Level I, 72% of Level II, and 59% of Level III centers responding. Of the 169 Level I centers, 31 (18%) reported their trauma surgeons perform the full complement of thoracic, vascular, and abdominal cases. Trauma surgeons managed the full range of injuries at 11 (6%) of the 187 Level II centers and 7 (4%) of the 159 Level III centers. At these 49 centers, only 41% of surgeons perform elective thoracic and vascular cases. The remaining 466 centers enlist a combination of vascular and thoracic surgeons to manage trauma patients. Finally, trauma surgeons performed cranial burr holes at eight trauma centers, placement of ICP monitors at four, and open fracture washout at three trauma centers.
The model of the acute care surgeon is attractive and timely, but only a limited number of trauma surgeons currently practice this proposed range of operative procedures; even fewer surgeons have an elective surgical practice to maintain key operative skills. Fellowship training programs need to incorporate vascular and thoracic procedures to enable the specialty of acute care surgery.
作为创伤外科扩展领域的急性 care 外科这一不断发展的学科正受到强烈批评。在我们设想这种新的外科实践模式时，评估全国创伤中心的当前状况是至关重要的一步。本研究的目的是确定美国各大创伤中心创伤外科医生的实践模式。
向美国创伤协会列出的 1288 家指定创伤中心的创伤主任发送了一份调查问卷。按照提议，急性 care 外科将包括进行紧急腹部、血管和胸部创伤手术以及提供重症监护。已考虑增加简单的骨科和神经外科手术。
I/II/III 级中心（n = 515）的调查回复率为 72%，其中 I 级中心回复率为 92%，II 级中心为 72%，III 级中心为 59%。在 169 家 I 级中心中，31 家（18%）报告其创伤外科医生进行全部的胸部、血管和腹部病例手术。在 187 家 II 级中心中的 11 家（6%）以及 159 家 III 级中心中的 7 家（4%），创伤外科医生处理所有类型的损伤。在这 49 家中心，只有 41%的外科医生进行择期胸部和血管手术。其余 466 家中心联合血管外科医生和胸外科医生来管理创伤患者。最后，创伤外科医生在 8 家创伤中心进行颅骨钻孔，在 4 家放置颅内压监测器，在 3 家创伤中心进行开放性骨折清创冲洗。
急性 care 外科医生模式具有吸引力且适时，但目前只有少数创伤外科医生实施这一提议的一系列手术操作；进行择期手术以维持关键手术技能的确外科医生更少。专科培训项目需要纳入血管和胸部手术，以使急性 care 外科成为一个专业。
