J Trauma
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Advanced-level general surgery residents were surveyed about their interest in providing trauma care upon completion of their residency training. Questionnaires were sent to 1,795 residents and 886 (49%) replied. Two thirds of the residents stated that trauma was a rewarding field, but only 18% wanted it as a career or as a major part of their practice. ⋯ Primary reasons for these negative feelings were the large amount of nonoperative care rendered in treating blunt trauma patients and the unsavory type of patients encountered with most penetrating trauma injuries. Lifestyle issues were important but were not rated as high as other factors. Complaints about the structure of current trauma rotations in many institutions and the negative impact of many trauma surgeons as role models were frequently cited as reasons for respondents not pursuing trauma care as a career interest.
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Rectal examination with guaiac testing is a standard part of the emergency department evaluation of acutely traumatized patients. Its major role is in the recognition of occult bowel injury. We questioned its efficacy in detecting occult rectal injury in patients with penetrating trauma. ⋯ Sensitivity was 100% (8/8) when the two were combined. Our findings suggest that guaiac testing is not accurate enough to rule out the presence of occult rectal injury. The result of guaiac testing must not influence the decision to further evaluate patients with high-risk injuries.
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The published evaluation of methods for identifying preventable trauma deaths contains many unstudied confounding factors. To investigate the reliability of methods for identifying such preventable deaths, we compared three consensus systems using separate five-member general review panels assessing 20 non-central nervous system fatalities: panel A, independent judgments; panel B, discussion of all cases preceding individual judgments; and panel C, independent judgments followed by discussion and equivocal case reassignment. The Kappa concordance index was low for all methods (method A, 0.20; methods B and C, 0.40). ⋯ Thus different consensus methods yielded different results. We conclude that individual case review can be severely flawed and therefore should not be used to measure institutional quality of patient care. We recommend that assessment of institutional performance should be based on objective evaluation methods, which require the study of patient population outcomes, rather than on subjective methods in which individual cases are reviewed.