Surgical residents' knowledge of injury prevention principles

American Association for the Surgery of Trauma Prevention Committee topical update: Impact of community violence exposure, intimate partner violence, hospital-based violence intervention, building community coalitions and injury prevention program evaluation

An effective injury prevention program is an important component of a successful trauma system. Maintaining support for a hospital-based injury prevention program is challenging, given competing institutional and trauma program priorities and limited resources. In light of those pressures, the American College of Surgeons Committee on Trauma mandates that trauma centers demonstrate financial support for an injury prevention program as part of the verification process, recognizing that hospital administrators might see such support as discretionary and ripe as a target for expense reduction efforts. This Topical Update from the American Association for the Surgery of Trauma Injury Prevention Committee focuses on strategies to be more effective with the limited resources that are allocated to hospital-based injury prevention programs. First, this review tackles two of the many social determinates of violence, including activities aimed at mitigating the impact of both community violence exposure and intimate partner/domestic violence. Developing or participating in coalitions for injury prevention, both in general with any injury prevention initiative, and specifically while developing a hospital-based violence intervention program, efficiently extends the hospital's efforts by gaining access to expertise, resources, and influence over the target population that the hospital might otherwise have difficulty impacting. Finally, the importance of systematic program evaluation is explored. In an era of dwindling resources for injury prevention, both at the national level and the institutional level, it is important to measure the effectiveness of injury prevention efforts on the target population, and when necessary, make changes to programs to both improve their effectiveness and to assist organizations in making wise choices in the use of their limited resources.

Injury Prevention in Medical Education: A Systematic Literature Review

OBJECTIVE

Traumatic injury is the first cause of death for Canadians aged 1 to 44 years old. To reduce the global burden of injury, the need for healthcare professionals with injury prevention proficiency is growing. The aim of this study was to review the literature to identify and analyze current injury prevention curriculums amongst medical undergraduate and residency programs.

DESIGN

A systematic literature review (no date restriction was used) was conducted using Embase, Medline, ERIC, and CINAHL. Three reviewers independently selected studies, extracted data, checked accuracy, assessed risk of bias, and assessed quality. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guideline was followed. The study was registered with PROSPERO, #CRD42016048805.

PARTICIPANTS

Articles were included if they were peer-reviewed, published in the English language, and reported data on injury prevention and control curriculum.

RESULTS

Eight hundred and twenty-four articles were identified with the initial search strategy. Internal consistency reliability, generalizability, evidence for content, criterion-related and construct validity was performed. The systematic review synthesized the characteristics (population, intervention type, outcome measures) described in the literature. This review is the first step in identifying gaps in injury prevention teaching and curriculums for medical students and residents.

CONCLUSION

The number of studies reporting the incidence and/or effectiveness of injury prevention and control curriculum is limited across the literature. Therefore, there is a knowledge gap in providing injury prevention education. Given that physicians play a vital role in the prevention or control of injuries, further development of medical undergraduate and residency programs to include core concepts of injury prevention would be unquestionably paramount.

American Association for the Surgery of Trauma Prevention Committee topical overview: National Trauma Data Bank, geographic information systems, and teaching injury prevention

BACKGROUND

Injury is the leading cause of death for all Americans aged 1 to 35 years, and injury-related costs exceed $100 billion per year in the United States. Trauma centers can be important resources for risk identification and prevention strategies. The authors review 3 important resources for injury prevention education and research: the National Trauma Data Bank, geographic information systems, and an overview of injury prevention education.

DATA SOURCES

The National Trauma Data Bank and the Trauma Quality Improvement Program are available through the Web site of the American College of Surgeons. Links to research examples using geographic information systems software and the National Trauma Data Bank are provided in the text. Finally, resources for surgical educators in the area of injury prevention are summarized and examples provided.

CONCLUSIONS

Database research, geographic information systems, and injury prevention education are important tools in the field of injury prevention. This article provides an overview of current research and education strategies and resources.

Injury prevention education in medical schools: an international survey of medical students

BACKGROUND

Injuries account for an estimated 9% of global mortality. Health professionals worldwide receive little formal injury prevention training, especially in developing countries.

OBJECTIVE

To identify injury prevention training topics taught in a sample of medical schools throughout the world.

DESIGN AND SETTING

Cross sectional survey of 82 medical schools from 31 countries. Based on a convenience sample, respondents recalled the injury prevention concepts they were taught, estimated the time dedicated to these topics, specified the courses and rotations where these concepts were taught, and noted whether they were compulsory or elective sessions.

PARTICIPANTS

Medical students in their last year of medical training.

MAIN EXPOSURE MEASURES

Student recall of classes and rotations where topics of injury prevention and control were discussed.

RESULTS

Basic injury prevention concepts including risk factors for injuries and injury classification systems were not covered in 60% of medical schools. Concepts related to child abuse and neglect and emergency care were more commonly taught than others such as traffic injury prevention and youth violence prevention. In general, injury prevention and control concepts were less frequently taught in Middle Eastern and African universities compared with other regions and some topics such as violence prevention were more frequently taught in medical schools in the Americas. Injury prevention concepts were taught most frequently in preventive medicine, forensic medicine, emergency medicine, surgery and pediatrics courses, and rotations.

CONCLUSIONS

Injury prevention and control education is infrequent and fragmented in medical schools around the world. Inclusion or further development of curricula on this subject could benefit prevention and control efforts.

Injury Patterns among Female Trauma Patients: Recognizing Intentional Injury

BACKGROUND

Intimate partner violence and interpersonal violence are a major source of morbidity and mortality among women. Our objective was to identify patterns of injury consistent with intentional injury in female trauma patients admitted to the hospital.

METHODS

Subjects were women aged 16 to 65 years discharged from acute care hospitals in a single year with a primary diagnosis of injury. Data were collected from 14 states across the United States. Analysis was performed using multivariate logistic regression.

RESULTS

Women who suffered blunt intentional trauma exhibited very different injury patterns than those hospitalized for motor vehicle collisions or falls. The risk of facial injury with blunt intentional trauma was much higher than for other mechanisms (odds ratio, 4.9; 95% confidence interval, 4.20-5.74). Head injury was also more common in these women (odds ratio, 1.4, 95% confidence interval, 1.15-1.70).

CONCLUSION

Physicians can potentially improve identification of cases of intimate partner violence and interpersonal violence by understanding common injuries associated with interpersonal violence.

Predicting Future Injury among Women in Abusive Relationships

STUDY OBJECTIVE

Intimate partner violence (IPV) is a major cause of injury and death among women, and it is a problem with significant relevance to health care providers. In this study, we examined risk factors for IPV-related injury within 9 months of an index episode of abuse in a population of police- or court-identified victims of IPV.

METHODS

This was a prospective cohort study of 354 women in abusive relationships. The outcome measured was injury within 9 months. Stepwise logistic regression was used for the statistical analysis.

RESULTS

Two factors were found to be independently associated with increased risk of injury: victim's lack of full-time employment (RR 3.47, 95% CI 1.43-8.41) and physical abuse on the index incident date (RR 3.06, 95% CI 1.16-8.06).

CONCLUSIONS

By questioning our patients about these issues, we can begin to identify the complex risk factors that predispose women in abusive relationships to future injury.

Surgeons and injury prevention: what you don't know can hurt you!

BACKGROUND

The most effective treatment for traumatic injuries is to prevent them from occurring. Currently, few surgeons receive any formal training in injury' control and prevention. This study was designed to test the knowledge of injury prevention principles among practicing surgeons, in order to identify areas in need of intensified educational efforts.

STUDY DESIGN

Survey questions designed by members of the American College of Surgeons Committee on Trauma were programmed into a specialized touch-screen computer, which was displayed at four different surgery and trauma meetings, including the ACS Clinical Congress in 1999 and 2000. Participants were questioned about their knowledge of trauma epidemiology, bicycle helmet effectiveness, child safety seat usage, suicide, and domestic violence.

RESULTS

Seventy-nine surveys were completed by surgeons, including 33 specializing in trauma care, and by 106 nurses attending trauma courses. Overall, the percentage of correct answers was 50%. There were no significant differences in survey scores between trauma surgeons and general surgeons, although both scored higher than trauma nurses. Areas where knowledge deficits were the most apparent included proper use of child safety seats, the effectiveness of airbags, the prevalence of suicide, and the annual cost of injury in America.

CONCLUSIONS

The majority of practicing surgeons and nurses, including those working at trauma centers, are unaware of the basic concepts of injury prevention. Advancements in the field of injury control will require efforts to educate medical professionals and the public.