RT Journal Article
SR Electronic
T1 The evolution of trauma surgery at a high-volume Canadian centre: implications for public health, prevention, clinical care, education and recruitment
JF Canadian Journal of Surgery
JO CAN J SURG
FD Canadian Medical Association
SP 19
OP 23
DO 10.1503/cjs.001314
VO 58
IS 1
A1 Chad G. Ball
A1 Debanjana Das
A1 Derek J. Roberts
A1 Christine Vis
A1 Andrew W. Kirkpatrick
A1 John B. Kortbeek
YR 2015
UL http://canjsurg.ca/content/58/1/19.abstract
AB Background: Trauma centres continue to evolve with respect to clinical care and their impact on public health. Despite improvements in patient outcomes, operative volumes, and therefore maintenance of surgical skills, has become a challenging issue. We sought to determine whether injury demographics and treatments at a high- volume centre changed over time.Methods: We used the Alberta Trauma Registry to analyze all severely injured (injury severity score [ISS] ≥ 12) patient admissions over a 16-year period (1995–2011).Results: Of the 12 879 severely injured patients requiring admission, there was a 1.5-fold increase in the annual admission rate despite population normalization (p = 0.001). Over the 16-year interval, patients were older with a subsequent lower mortality (p = 0.001) and length of hospital stay (p = 0.007). In patients with the most severe ISS (≥ 48), there was no change in mortality (27%, p = 0.26). In 2011, falls were the most common mechanism compared with motor vehicle crashes (41% v. 23%; p < 0.001); this was a complete reversal compared with 1995 (25% v. 41%). Motorized recreational vehicle and motorcycle injuries also increased (p < 0.001). The mean number of operations performed by trauma surgeons decreased (laparotomies: 67 [17%] in 1995 v. 47 [5%] in 2011, p < 0.001). Thoracotomies and tracheostomies remained unchanged (p = 0.19).Conclusion: Clinical care has improved despite an increasing overall volume of severely injured patient admissions. The number of operative interventions performed by trauma surgeons continues to decrease concurrent to a change in injury mechanisms. Despite these improvements, maintenance of technical skills among trauma surgeons has become an important issue.