Surgical Internet at a Glance:Volume VI

Jeff Allen, MD, Louisville, Kentucky

The care of the complex trauma patient is one of thefastest changing aspects of modern surgical care.The science of trauma surgery has remained “ahead

of the curve” in embracing new technologies such as diag-nostic ultrasonography and interventional angiography.Not surprisingly, trauma has been at the forefront of thesurgical internet, with numerous web pages having quite alot of information to offer.

The web page http://www.trauma.org is subtitled “Careof the Injured,” and offers a wealth of data about themedical treatment of trauma patients and education ofdoctors. The trauma bank section of this web page is theinformation headquarters, and there are 14 categories inthe bank. In the “trauma radiology” section of the bank,one may find excellent examples of plain radiographs andCT scans of injuries such as pneumothorax, hemothorax,and aortic transection. Each of these is a high-resolutionimage that can be enlarged with a click of the mouse.There is a “trauma mailing list” section here and in othersections of the bank that functions as a question andanswer session for the page.

Also in the trauma bank are case presentations thatinclude a written history and physical examination, imagesof the radiographs for each case, and intraoperative pho-tographs. Some of the cases presented include “Renal lac-eration after blunt trauma,” “Penetrating head injury with-out neurological deficit” and “Fracture-dislocation of C2/3treated with lag-screw fixation.” A concise look at traumascoring systems is presented in the bank, including Glas-cow Coma Scale, Abbreviated Injury Scale, Injury SeverityScore, and the Revised Trauma Score. Additional catego-ries within the bank include injury prevention, prehospitalcare, resuscitation, and trauma anesthesia.

There is a moulage on the web page that requires eitherNetscape Navigator 2.0, Internet Explorer 3.01 (or later),or any internet browser that supports frames. Currently,there are three cases at the moulage allowing an interac-tive simulation of the care of a trauma patient. At anyinstance, a photograph is displayed in the right uppercorner while the patient’s vital signs are shown in the leftupper corner. The examinee is given a series of binarychoices aimed at testing his or her knowledge of caring forthe injured patient. Fundamental concepts, such as estab-lishing and maintaining an airway and the orderly steps ofpatient care, are emphasized. One wrong move and themoulage is over with an insulting phrase like “You can’t

hear any breath sounds. Come to think of it, you can’thear any heart sounds either.” Although some of the ques-tions in the moulage may be misinterpreted, it is a goodexercise, especially for medical students and junior-levelsurgery residents, and a good review for more senior sur-geons.

The generalized Trauma list provides a forum for healthcare professionals to discuss cases and issues. The currentmembership is over 600 people. The resources section oftrauma.org includes upcoming meetings, ATLS courseschedules, a listing of trauma-related fellowships, and anextensive links section. Self-summarizing, “Trauma.org ex-ists to promote and disseminate the knowledge and prac-tice of injury prevention and trauma care throughout theworld.” The web page is a busy one, with already more than3.1 million page accesses.

The Eastern Association for the Surgery of Trauma(http://www.east.org) is a web page worth mentioningbased on its practice management guidelines alone. Theuse of clinical practice guidelines is a new phase of medicalcare that minimizes the geographic variability in the treat-ment of difficult surgical problems while attempting toproceed in an evidence-based manner.

Each of the practice parameters and guidelines sectionspresent a surgical problem, the process of resolving theproblem, levels of recommendations, the scientific founda-tion of the recommendations, future investigations, andreferences. The scientific foundation is class I if based onprospective randomized controlled trials, class II if col-lected prospectively, and retrospective analyses which werebased on clearly reliable data, and class III if based onretrospectively collected data. The recommendations aresimilarly graded level I, II, and III.

With these criteria in mind, surgical problems, such asscreening for blunt cardiac injuries, identifying cervicalspine injuries following trauma, penetrating colon injuries,and prophylactic antibiotics in penetrating abdominaltrauma, are reviewed and recommendations made. For in-stance, the problem of determination of the stability of thecervical spine is discussed in detail at this web page withthe emphasis on clinical parameters guidelines. Based onavailable data, no level I recommendations are made. How-ever, the level II recommendation is that trauma patientswho are awake, alert, without neck or distracting pain, andhave no neurologic deficits do not need radiologic studiesof the cervical spine. Similar recommendations are madefor 10 current trauma surgical problems with the data andreasoning discussed.

Also at the EAST web page is a searchable membershiplist, fellowship and job opportunities, meeting informa-tion, links and an online registration for the annualmeeting.

Am J Surg. 1998;176:229.Address correspondence to Jeff Allen, MD, 1114 Everett Ave-

nue, Louisville, Kentucky 40204.E-mail address: jeffa@iglou.com

SURGICAL INTERNET

486 © 1998 by Excerpta Medica, Inc. 0002-9610/98/$19.00All rights reserved. PII S0002-9610(98)00191-3