title: The impact of patient volume on surgical trauma training in a Scandinavian trauma centre.
abstract: OBJECTIVE
  Some of the problems faced in trauma surgery are increasing non-operative management of abdominal injuries, decreasing work hours and increasing sub-specialisation. We wanted to document the experience of trauma team leaders at the largest trauma centre in Norway, hypothesising that the patient volume would be inadequate to secure optimal trauma care.
  
  
  METHODS
  Patients registered in the hospital based Trauma Registry during the 2-year period from 1 August 2000 to 31 July 2002 were included.
  
  
  RESULTS
  Of a total of 1667 patients registered, 645 patients (39%) had an Injury Severity Score (ISS)>15. Abdominal injuries were diagnosed in 205 patients with a median ISS of 30. An average trauma team leader assessed a total of 119 trauma cases a year (46 patients with ISS>15) and participated in 10 trauma laparotomies.
  
  
  CONCLUSIONS
  Although the total number of trauma cases seems adequate, the experience of the trauma team leaders with challenging abdominal injuries is limited. With increasing sub-specialisation and general surgery vanishing, fewer surgical specialties provide operative competence in dealing with complicated torso trauma. A system of additional education and quality assurance measures is a prerequisite of high quality, and has consequently been introduced in our institution.
authors.affiliation: Department of Gastrointestinal Surgery, Ullevaal University Hospital, Kirkeveien 166, 0407 Oslo, Norway. tinagaar@online.no
authors.forename: Christine
authors.initials: C
authors.lastname: Gaarder
authors.forename: Nils Oddvar
authors.initials: NO
authors.lastname: Skaga
authors.forename: Torsten
authors.initials: T
authors.lastname: Eken
authors.forename: Johan
authors.initials: J
authors.lastname: Pillgram-Larsen
authors.forename: Trond
authors.initials: T
authors.lastname: Buanes
authors.forename: Paal Aksel
authors.initials: PA
authors.lastname: Naess
mesh_terms: D000005:Abdomen / Q000601:surgery; D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery; D000328:Adult; D002983:Clinical Competence; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011787:Quality of Health Care; D014193:Trauma Centers; D016526:Workload; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery*