Societal impact on surgical education in trauma

Societal and demographic changes within Detroit have affected the incidence of trauma treated at the Detroit Medical Center. Using liver injury as an index, this phenomenon was studied by comparing 122 patients treated in 1972 with 38 patients treated in 1981. During 1972 76 patients had major injuries, compared to 13 patients in 1981. Intraoperative hemostasis of an actively bleeding liver in 1972 was achieved by liver suture (43 patients), resectional debridement through a nonanatomic plane (three patients), hepatic artery ligation (three patients), anatomic segmentectomy or lobectomy (four patients), and intrahepatic packing with later removal (one patient). During 1981, 13 patients had persistent bleeding requiring intraoperative hemostasis by liver suture (12 patients) or resectional debridement (one patient). This decline in trauma reflects a reduced city population, the dilutional effect of a four-quadrant emergency medical service begun in the mid 1970's, the implementation of a state gun law, and reduced citizen compliance to violence. These changes likely are not unique to Detroit and highlight the need for a National Trauma Registry which would not only help program directors design a meaningful trauma rotation but also help hospital planners accommodate to changes in patient exposure.