Trauma Surgeon Decision-Making: Surviving Outside the Realm of the Evidence Based
Trauma surgery is inherently a decision intense specialty and trauma surgeons make impactful decisions on a nearly constant basis. Rarely are sufficient data and time available to weigh options, thus the individual trauma surgeon is left to act based on his or her best judgment and experience. Decision-making is not a homogeneous process with widely agreed-upon principles and processes and there has been little research into how trauma surgeons make decisions. The current state of decision-making in trauma surgery consists of making do without either comprehensive baseline data or the luxury of enough time to gather needed information. Although consensus guidelines and algorithms are helpful, trauma surgeons must still make decisions on a regular basis without the benefit of a full dataset and under time pressures. This chapter attempts to provide an overview of theoretical constructs proposed for modeling decision-making, incorporate a brief review of the evolution of trauma decision-making, and incorporate the author’s personal viewpoints as a practicing trauma surgeon.
KeywordsDecision-making Trauma Surgery Heuristics Bias Medical error Head injury Splenectomy
- 7.Ioannidis JPA. Why most published research findings are false. PLoS Med. 2005;2:696–701.Google Scholar
- 10.Jayaraman S, Sethi D, Chinnock P, Wong R. Advanced trauma life support training for hospital staff. Cochrane Database Syst Rev. 2014;8:CD004173.Google Scholar
- 21.Fakhry SM, Watts DD, Luchette FA, the EAST Multi-Institutional HVI Research Group. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury (SBI): an analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial. J Trauma. 2003;54:295–306.CrossRefPubMedGoogle Scholar
- 22.Cook MR, Holcomb JB, Rahbar MH, Fox EE, Alarcon LH, Bulger EM, Brasel KJ, Schreiber MA, PROMMTT Study Group. An abdominal computed tomography may be safe in selected hypotensive trauma patients with positive focused assessment with sonography in trauma examination. Am J Surg. 2015;209:834–40.CrossRefPubMedPubMedCentralGoogle Scholar
- 23.Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Report of the institute of medicine. Washington: National Academy Press; 1999.Google Scholar
- 26.Layde PM, Kuhn E, Maas L, Hargarten S. Wisconsin Injury Research Center surveillance criteria for medical injuries. WIRC working papers No. 1, 2000. http://www.family.mcw.edu/medoinjosurv1.pdf.