From the Department of Surgery (P.B.A., E.A.E., M.W.B.), Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, Maryland; Department of Trauma (J.C.G.), San Antonio Military Medical Center; Joint Trauma System, DHA Combat Support (J.C.G., K.R.G.), San Antonio, Texas; and AMEDD Military Civilian Trauma Team Training (M.J.B., K.R.G.), Cooper University Hospital, Camden, New Jersey.
J Trauma Acute Care Surg. 2024 Aug 1;97(2S Suppl 1):S74-S81. doi: 10.1097/TA.0000000000004389. Epub 2024 May 15.
The clinical demands of mass casualty events strain even the most well-equipped trauma centers and are especially challenging in resource-limited rural, remote, or austere environments. Gynecologists and urologists care for patients with pelvic and abdominal injuries, but the extent to which they are able to serve as "force multipliers" for trauma care is unclear. This study examined the abilities of urologists and gynecologists to perform 32 trauma procedures after mentored training by expert trauma educators to inform the potential for these specialists to independently care for trauma patients.
Urological (6), gynecological surgeons (6), senior (postgraduate year 5) general surgery residents (6), and non-trauma-trained general surgeons (8) completed a rigorous trauma training program (Advanced Surgical Skills Exposure in Trauma Plus). All participants were assessed in their trauma knowledge and surgical abilities performing 32 trauma procedures before/after mentored training by expert trauma surgeons. Performance benchmarks were set for knowledge (80%) and independent accurate completion of all procedural components within a realistic time window (90%).
General surgery participants demonstrated greater trauma knowledge than gynecologists and urologists; however, none of the specialties reached the 80% benchmark. Before training, general surgery, and urology participants outperformed gynecologists for overall procedural abilities. After training, only general surgeons met the 90% benchmark. Post hoc analysis revealed no differences between the groups performing most pelvic and abdominal procedures; however, knowledge associated with decision making and judgment in the provision of trauma care was significantly below the benchmark for gynecologists and urologists, even after training.
For physiologically stable patients with traumatic injuries to the abdomen, pelvis, or retroperitoneum, these specialists might be able to provide appropriate care; however, they would best benefit trauma patients in the capacity of highly skilled assisting surgeons to trauma specialists. These specialists should not be considered for solo resuscitative surgical care.
Therapeutic/Care Management; Level IV.
即使是设备最齐全的创伤中心，也难以应对大规模伤亡事件带来的临床需求，而在资源有限的农村、偏远或恶劣环境中更是极具挑战性。妇科医生和泌尿科医生会诊治骨盆和腹部受伤的患者，但他们在创伤救治中能够起到多大的“增效作用”尚不清楚。本研究通过由创伤教育专家指导的培训，考察了泌尿科医生和妇科医生在掌握 32 项创伤操作技能后的能力，旨在了解这些专科医生是否有能力独立照顾创伤患者。
泌尿科医生（6 名）、妇科医生（6 名）、高年资（第 5 年住院医）普外科住院医（6 名）和非创伤培训普外科医生（8 名）完成了严格的创伤培训计划（高级创伤外科技能培训计划加）。所有参与者在接受创伤专家的指导培训前后，都要接受创伤知识和 32 项创伤操作技能的评估。知识评估的基准为 80%，在实际时间窗口内独立准确完成所有操作步骤的比例为 90%。
普外科住院医的创伤知识水平高于妇科医生和泌尿科医生；但没有任何一个专业达到 80%的基准。培训前，普外科和泌尿科住院医的整体操作能力优于妇科医生。培训后，只有普外科住院医达到了 90%的基准。事后分析显示，在执行大多数骨盆和腹部操作时，各组之间没有差异；然而，在提供创伤救治时的决策和判断相关知识，即使在培训后，仍明显低于基准水平，妇科医生和泌尿科医生尤其如此。
对于生理稳定、腹部、骨盆或后腹膜创伤的患者，这些专科医生可能能够提供适当的治疗；但作为创伤专家的高技能助手，他们会更有益于创伤患者。这些专科医生不应被视为单独进行复苏性外科治疗的人选。
治疗/护理管理；IV 级。
