Book Review

Complications in Trauma and Critical Care

N Engl J Med 1996; 335:1247-1248October 17, 1996

Article

Complications in Trauma and Critical Care
By Kimball I. Maull, Aurelio Rodriguez, and Charles E. Wiles, III. 573 pp., illustrated. Philadelphia, W.B. Saunders, 1996. $110. ISBN: 0-7216-4940-8

Injury is the leading cause of death between the ages of 1 and 44 years. Unintentional injury cost this country $407 billion in 1993 alone. Despite this enormous economic toll, we spend relatively little on the prevention and care of trauma as compared with cancer or heart disease. Technical expertise aside, an important attribute of those who care for injured patients is good judgment. The care of these patients, or any patient, “consists largely in balancing probabilities,” to quote Osler, which means that complications will occur despite excellent judgment. As Donald Trunkey states in the foreword to Complications in Trauma and Critical Care, a book is not a substitute for personal experience, but it may help refine one's judgment. In this book, leading authorities in trauma care share their experiences in the prevention, recognition, and treatment of trauma-related complications. The title of the book is a bit misleading, since critical care makes up a relatively minor section. Given the excellent critical care textbooks now available, future editions of this book might delete these few chapters. The opening chapters detail the systemic response to injury and provide insight into therapy aimed at minimizing the untoward effects of this response. The remainder of the book, except for the chapters on trauma systems and quality improvement, reviews specific organs and injuries. The Committee on Trauma of the American College of Surgeons has been a leader in hospital-wide improvements in multidisciplinary care of the injured. Appropriately, this book includes a primer in quality improvement in trauma care.

A problem with many multiauthored books (and this one is no exception) is the lack of a consistent style. Nevertheless, there is a wealth of information regarding the recognition and treatment of trauma-specific complications that occur early in the course of treatment. Many of the chapters — “Pitfalls in the Diagnosis of Abdominal Trauma” and “Deep Venous Thrombosis and Pulmonary Embolism,” for example — include the authors' own algorithms, which have been derived from the literature and modified by experience; these algorithms should allow readers to refine their own treatment plans. Subsequent editions would be strengthened considerably if all of the chapters provided such guidance.

Trauma is a vast subject that spans multiple specialties. The intended audience for this book is general trauma specialists; therefore, the inclusion of chapters on facial fractures, orthopedic trauma, and other special types of surgical injuries may at first seem out of place. However, these chapters focus primarily on topics and complications that will be managed by the trauma generalist.

If Trunkey is correct that a book can refine one's judgment, this book will be a useful addition to the library of the surgical resident, emergency-medicine physician, or general surgeon who cares for trauma patients. Learning from mistakes is essential; learning from the experience of others may help prevent mistakes.

William G. Cioffi, M.D.
Brown University School of Medicine, Providence, RI 02903