title: Surgical management of blunt thoracic and abdominal injuries in Quebec: a limited volume.
abstract: BACKGROUND
  Trauma care of thoracic and abdominal injuries is currently in turmoil because of both a decrease in the number of these injuries and a concomitant increase in their nonsurgical management. The goal of this study was to evaluate the incidence of thoracic and abdominal injuries in the province of Quebec and the number of associated surgical procedures.
  
  
  METHODS
  Patients with blunt thoracic or abdominal injuries taken to a tertiary trauma center in the province of Quebec from April 1, 1998 to March 31, 2002 were identified. Patients who were dead on arrival were excluded. Only patients with an Abbreviated Injury Scale score > or =2 for the thoracic or abdominal regions were included.
  
  
  RESULTS
  During the study period, a total of 16,430 blunt trauma patients were admitted to one of the four trauma centers. A total of 2,660 (16.2%) patients sustained thoracic and/or abdominal injuries with an Abbreviated Injury Scale score >1. Among these, the median Injury Severity Score was 24 (range: 4-75) and the in-hospital mortality rate was 11.0%. There were 2,196 patients (82.5%) with thoracic injuries, 977 patients (36.7%) with abdominal injuries, and 520 patients (19.5%) with injuries to both regions. A surgical intervention was undertaken in 76 patients with thoracic injuries (3.5%) and in 414 patients with abdominal injuries (42.3%). On average, 4.7 thoracic and 28.8 abdominal trauma procedures were performed per center, yearly. Each trauma surgeon performed, on average, less than one thoracic and less than five abdominal trauma procedures yearly.
  
  
  CONCLUSIONS
  The incidence of blunt thoracic and abdominal injuries needing surgical intervention is low in Quebec tertiary trauma centers. The competence of general surgeons in trauma-related procedures might be compromised by such low patient volume unless they frequently perform non-trauma surgical procedures. We think that in Quebec, trauma care must be provided by surgeons who practice both acute emergency and elective surgical care in addition to trauma care. These findings should have an important impact on the development of on-going education and resident training programs.
authors.affiliation: Department of Traumatology, Charles LeMoyne Hospital, University of Sherbrooke, Greenfield Park, Canada. eric.bergeron@traumaquebec.org
authors.forename: Eric
authors.initials: E
authors.lastname: Bergeron
authors.forename: Andre
authors.initials: A
authors.lastname: Lavoie
authors.forename: Amina
authors.initials: A
authors.lastname: Belcaid
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: David
authors.initials: D
authors.lastname: Clas
authors.forename: Tarek
authors.initials: T
authors.lastname: Razek
authors.forename: Julie
authors.initials: J
authors.lastname: Lessard
authors.forename: Sebastien
authors.initials: S
authors.lastname: Ratte
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology* / Q000601:surgery; D000058:Accidental Falls / Q000706:statistics & numerical data; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011792:Quebec / Q000453:epidemiology; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data; D013898:Thoracic Injuries / Q000453:epidemiology* / Q000601:surgery; D014193:Trauma Centers / Q000706:statistics & numerical data; D014949:Wounds, Nonpenetrating / Q000453:epidemiology* / Q000601:surgery