Department of Surgery Education, Iowa Methodist Medical Center, Des Moines, Iowa 50309-1453, USA.
J Surg Educ. 2011 Jul-Aug;68(4):313-7. doi: 10.1016/j.jsurg.2011.02.003. Epub 2011 Apr 1.
During the last 2 decades, the advent of new technologies in trauma patient care may have resulted in a decreased number of diagnostic peritoneal lavage (DPL) evaluations. In this study, it is hypothesized that fewer DPL are being performed at a midwestern trauma center. Such negative trends may make the inclusion of DPL in current trauma education potentially outdated and no longer universally appropriate in trauma evaluation algorithms.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective observational study of a level I trauma center includes patients from January 1998 through September 2010. The total number of trauma-related DPL procedures performed annually during the study period was determined along with accompanying facility and trauma patient level data.
A total of 24 DPLs were performed at the target trauma center during the study period. There was a significant decrease (p = 0.0018) in the use of DPL despite a significant increase (p < 0.0001) in the proportion of trauma patients with an injury severity score > 15.
Study data demonstrated a decrease in the use of DPL as a diagnostic modality in the evaluation of blunt abdominal trauma patients at a medium-sized midwestern center. These data provide historic facility-level evidence of a practice change. Such information may support a recommendation that the American College of Surgeons revisit its current curriculum for Advanced Trauma Life Support (ATLS). Specifically, we propose the American College of Surgeons consider changing DPL instruction to an optional component of ATLS. COMPETENCIES: Patient Care, Medical Knowledge, Practice Based Learning and Improvement.
在过去的 20 年中，创伤患者治疗中新技术的出现可能导致诊断性腹腔灌洗（DPL）检查的数量减少。本研究假设在中西部创伤中心进行的 DPL 检查较少。这种负面趋势可能使 DPL 纳入当前创伤教育的可能性过时，并且不再普遍适用于创伤评估算法。
设计、设置和参与者：这是一项对一级创伤中心的回顾性观察性研究，纳入了 1998 年 1 月至 2010 年 9 月期间的患者。确定了研究期间每年进行的创伤相关 DPL 手术的总数，以及相关设施和创伤患者的级别数据。
在研究期间，目标创伤中心共进行了 24 例 DPL。尽管损伤严重程度评分> 15 的创伤患者比例显著增加（p < 0.0001），但 DPL 的使用显著减少（p = 0.0018）。
研究数据表明，在中型中西部中心评估钝性腹部创伤患者时，DPL 的使用作为诊断手段有所减少。这些数据提供了历史性的设施水平实践变化的证据。此类信息可能支持美国外科医师学院重新考虑其当前高级创伤生命支持（ATLS）课程的建议。具体来说，我们建议美国外科医师学院考虑将 DPL 指导作为 ATLS 的可选组成部分。能力：患者护理、医学知识、实践基础学习和改进。
