Survey of trauma surgeon practice of emergency department thoracotomy

Dennis, Bradley M.; Medvecz, Andrew J.; Gunter, Oliver L.; Guillamondegui, Oscar D.

doi:10.1016/j.amjsurg.2015.10.031

Cited by 21 publications

(7 citation statements)

References 13 publications

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“…Possible explanations for the two procedures with less emphasis on regular practice include the lack of perceived need for venous cutdown with improvements in intraosseous access devices,20 and the infrequent need for a highly skilled and somewhat controversial procedure such as ED thoracotomy 21…”

Section: Discussionmentioning

confidence: 99%

Preferred learning modalities and practice for critical skills: a global survey of paediatric emergency medicine clinicians

et al. 2018

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ObjectiveTo describe senior paediatric emergency clinician perspectives on the optimal frequency of and preferred modalities for practising critical paediatric procedures.MethodsMulticentre multicountry cross-sectional survey of senior paediatric emergency clinicians working in 96 EDs affiliated with the Pediatric Emergency Research Network.Results1332/2446 (54%) clinicians provided information on suggested frequency of practice and preferred learning modalities for 18 critical procedures. Yearly practice was recommended for six procedures (bag valve mask ventilation, cardiopulmonary resuscitation (CPR), endotracheal intubation, laryngeal mask airway insertion, defibrillation/direct current (DC) cardioversion and intraosseous needle insertion) by at least 80% of respondents. 16 procedures were recommended for yearly practice by at least 50% of respondents. Two procedures (venous cutdown and ED thoracotomy) had yearly practice recommended by <40% of respondents. Simulation was the preferred learning modality for CPR, bag valve mask ventilation, DC cardioversion and transcutaneous pacing. Practice in alternative clinical settings (eg, the operating room) was the preferred learning modality for endotracheal intubation and laryngeal mask insertion. Use of models/mannequins for isolated procedural training was the preferred learning modality for all other invasive procedures. Free-text responses suggested the utility of cadaver labs and animal labs for more invasive procedures (thoracotomy, intercostal catheter insertion, open surgical airways, venous cutdown and pericardiocentesis).ConclusionsPaediatric ED clinicians suggest that most paediatric critical procedures should be practised at least annually. The preferred learning modality depends on the skill practised; alternative clinical settings are thought to be most useful for standard airway manoeuvres, while simulation-based experiential learning is applicable for most other procedures.

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Section: Discussionmentioning

confidence: 99%

Preferred learning modalities and practice for critical skills: a global survey of paediatric emergency medicine clinicians

et al. 2018

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“…Prior studies have sought to understand variation in trauma management practice patterns (13,14). Nearly a decade ago, Yeung et al (15) surveyed both trauma surgeons from the AAST and urologists managing renal trauma and found significant variation in the workup and management of renal trauma.…”

Section: Original Articlementioning

confidence: 99%

High grade renal trauma management: a survey of practice patterns and the perceived need for a prospective management trial

Moses¹,

Anderson²,

Keihani³

et al. 2019

Transl. Androl. Urol.

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Background: To evaluate the current practice patterns of practitioners managing high grade renal trauma and determine perceived need for a prospective trial on the management of renal trauma. Methods:We distributed an electronic survey to members of the American Association for the Surgery of Trauma (AAST) and The Society of Genitourinary Reconstructive Surgeons (GURS). The survey evaluated demographics, interventional radiology (IR) access, and renal trauma management. Descriptive statistics were utilized to analyze participants' responses.Results: A total of 253 practitioners responded (age 48.4±10.4 years). The majority were acute care/trauma surgeons (ACS/TS) (63.2%), followed by urologists (34.4%) practicing at level 1 trauma centers (80.6%) in 39 US states. Most participants were in practice >10 years (62.8%); and had completed an ACS/TS (53.8%), or trauma/reconstructive urology (25.7%) fellowship. Ninety-five percent (241/253) found value in renal preservation with 74% utilizing IR embolization in the last year. However, there was wide variation in threshold for angiography, low rates of renal repair (24%) or packing (20%) and half reported performing a nephrectomy within the prior year. More than 80% believed there was value in a prospective trial to evaluate a protocol to decrease nephrectomy rates in renal trauma management. Conclusions:The majority of respondents had access to IR, reported comfort in renorrhaphy, and valued renal preservation. There was variation in thresholds for bleeding intervention, and nephrectomy was still a common management strategy. There is great interest among trauma surgeons and urologists for a prospective trial of renal trauma management aimed at decreasing nephrectomy when possible.

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“…Sannsynligvis forekommer det publiseringsskjevhet, gitt den store variasjonen studiene imellom (1). Det er også sprik mellom retningslinjer og klinisk praksis (2).…”

Section: Etikk Og Estetikk Ved Prehospital Torakotomiunclassified