Yes. This is a Missed Opportunity. Let's Turn Traumatic Injury into a Life-saving Event

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As an acute care surgeon, I frequently operate on patients with acute bowel perforations, including patients with cancer. In the not so distant past, I had just finished 1 such case on a middle-aged man with perforated sigmoid colon cancer. As I left the OR and waited for the elevator, a faculty colleague appeared and we began chatting. “What were you doing?” she asked. “Super nice guy- came in with obstructing colon cancer that perforated,” I responded. As we stepped into the elevator, we talked a bit more about the case (no one else was in the elevator), and we started discussing colonoscopy and prevention. We both got out on the same floor, and as we separated, this highly regarded colorectal surgeon remarked that one of the most important things she does is follow-up surveillance colonoscopies on her patients with previous colon cancer. Her comment clearly presumed that the burden of prevention of a future cancerous lesion in the remnant colon should be on the surgeon and system who had assumed care of the patient.
Should we not apply the same philosophy to penetrating trauma patients? I know, the 2 situations are quite different in scope, and preventing trauma recidivism is a highly complex endeavor. However, should we not take on this responsibility and prevent the disease of penetrating trauma from recurring? As pointed out in the study by Strong et al in this issue of the Annals, penetrating trauma recidivism is a well-known and major public health problem. Unfortunately though, in the past, only a few programs and surgeons had initiatives to address this issue. However, there is growing scientific evidence to support the usefulness of trauma recidivism programs, and how trauma surgeons are well equipped to lead them.
Over the past decade, we have seen an emergence of successful hospital-based violence prevention across the United States. The National Network of Hospital-Based Violence Intervention Programs (NNHVIP) is a collaborative of violence intervention programs championed by trauma surgeons, emergency medicine physicians, and public health professionals, dedicated toward supporting and rigorously evaluating emerging programs.1 Rochelle Dicker describes 3 tenets of successful hospital-based violence prevention programs: “The fidelity in the practice is based on violent injury serving as a teachable moment, culturally competent case management and addressing risks associated with violent injury.”2
These recent successes suggest that there is great potential for surgeon-led trauma recidivism prevention to be successful. Surgeons are in the unique position of saving lives, and we can use this relationship with our patients as leverage toward establishing a teachable moment. We can look toward our patient and say, “Since I saved your life, can I ask you something? What can we do to prevent this from ever happening again?” Even without a formal trauma recividism program, I have seen surgeons who have used these teachable moments, along with culturally competent case management techniques, to assist patients in navigating the complex risk factors of violent injury. Although sustainable violence prevention will take complex socioecological and multilevel interventions, 1 immediate step we as surgeons can take is to practice culturally dexterous care. This means treating each patient with curiosity, respect, and empathy, and leveraging our relationships to help prevent further harm to our patients, whether that be from violent injury, or harm from other easily preventable diseases.
In their well-done study, Strong et al provide an excellent argument for why prevention of trauma recidivism is desperately needed. But they also go one step further.
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