Surgeon-performed ultrasound for pneumothorax in the trauma suite.

BACKGROUND: Surgeon-performed ultrasound has become ubiquitous in the trauma suite. Initial reports suggest that sonography may be used for the detection of pneumothorax. The purpose of this study was to evaluate the efficacy of sonography to rule out the presence of a pneumothorax in the trauma population. METHODS: A prospective analysis of 328 consecutive trauma patients at an American College of Surgeons-verified Level I trauma center was undertaken. Thoracic ultrasound was performed before chest radiography. The presence or absence of a "sliding-lung" sign or "comet-tail" artifact was recorded. RESULTS: Of 328 evaluations, there were 312 true-negatives, 12 true-positives, 1 false-negative, 1 false-positive, and 2 exclusions. Specificity, negative predictive value, and accuracy were 99.7%, 99.7%, and 99.4%, respectively. CONCLUSION: Ultrasound is a reliable modality for the diagnosis of pneumothorax in the injured patient. This modality may serve as an adjunct or precursor to routine chest radiography in the evaluation of injured patients.

A survey of residents and faculty regarding work hour limitations in surgical training programs.

HYPOTHESIS: Surgical faculty and residents have significantly different attitudes regarding work hour restrictions. SETTING: All general surgery residencies approved by the Accreditation Council for Graduate Medical Education (ACGME). PARTICIPANTS: All voluntarily participating surgical faculty and residents. MAIN OUTCOME MEASURES: Current hours worked, days off per month, and attitudes and opinions regarding the current surgical-training environment. METHODS: A 17-question survey instrument was mailed to the program directors of all ACGME-approved surgical-training programs in the United States. They were requested to distribute the survey to all faculty and residents for completion and to return the forms for analysis. RESULTS: Responses (N = 1653) were received from 46% of surgical-training programs. A significant difference was noted between faculty and resident responses in most categories. Most residents (87%) reported more than 80 duty hours per week, whereas 45% reported working more than 100 hours per week. Only 30% of residents reported an average of 1 day per week free of clinical activities. Although a minority of residents (43%) felt that their workload was excessive, 57% felt that their cognitive abilities had been impaired by fatigue. A significant number of residents (64%) and faculty (39%) believe that duty hour restrictions should be adopted. A minority of residents (20%) and faculty (47%) believe that the duration of residency training should be increased to compensate for duty hour restrictions. One quarter of residents regret choosing a career in surgery. CONCLUSIONS: Current duty hours for most surgical residents exceed the proposed ACGME limits. Although most residents support duty hour limits; surgical faculty are less supportive. Significant alterations in the current design and structure of surgical-training programs will be required to meet the ACGME guidelines.