Book Review

Current Therapy of Trauma and Surgical Critical Care

Trauma: Contemporary Principles and Therapy

N Engl J Med 2008; 359:1078-1079September 4, 2008

Article

Current Therapy of Trauma and Surgical Critical Care
(Current Therapy.) Edited by Juan A. Asensio and Donald D. Trunkey. 785 pp., illustrated. Philadelphia, Mosby, 2008. $139. ISBN: 978-0-323-04418-9

Trauma: Contemporary Principles and Therapy
Edited by Lewis Flint, J. Wayne Meredith, C. William Schwab, Donald D. Trunkey, Loring W. Rue, and Paul A. Taheri. 784 pp., illustrated. Philadelphia, Lippincott Williams & Wilkins, 2008. $199. ISBN: 978-0-7817-5650-1

The statistics alone are daunting. In the United States, traumatic injury is the leading cause of death in the first four decades of life. On average, approximately 2 people are killed and 350 people have a debilitating injury every 10 minutes. Trauma accounts for more than 25% of all visits to emergency departments and about 12% of all hospital admissions, and the costs of caring for these patients are enormous. Practitioners who care for traumatically injured and critically ill surgical patients now have some assistance in the form of two new reference sources.

Critical care and trauma are vast subject areas, so much so that it is challenging to identify and then create a compelling blend of scientific theory and relevant research findings to inform an audience about safe, evidence-based approaches to diagnosis and treatment. It appears that the editors of these two books hope that theirs will serve as useful references for most practitioners (and especially for surgery trainees) and will organize their thinking by presenting the necessary fundamentals as guides to in-depth study. In each instance, authors with diverse backgrounds and expertise were recruited to contribute to the books.

There are other similarities between the two books. Each attempts to address the major relevant subject areas, though in many instances the treatment is abbreviated. Both books are somewhat plain, sparsely illustrated, monochromatic, and weighty tomes, with multiple chapters, written by many authors, that span more than 700 pages of text. Trauma has the advantage of being printed in a larger and more readable font, as well as providing access to an interactive Web site containing the entire content of the book, which facilitates study and enhances portability and accessibility.

Trauma also differs from Current Therapy of Trauma and Surgical Critical Care by taking a more holistic approach to the subject. There are major sections on the trauma system, the prevention and control of injury, the trauma center, and the trauma team, as well as discussions of ethics and compassionate care that constitute about a third of the book's content. Information on the optimal design and management of the modern trauma center is well considered and nicely presented. About 300 pages are devoted to the organization of the trauma team, the evolution of trauma nursing, and the training and development of trauma surgeons. The remainder of the book, in its longest sections, addresses specific issues regarding the care of patients. In these sections, there is a concerted effort to emphasize the scientific foundation underlying the modern approach to caring for the severely ill patient, including nonoperative management techniques. The book has some editorial inconsistencies, and its graphics tend to be rudimentary, but overall the presentation is sound.

In his preface to Current Therapy of Trauma and Surgical Critical Care, editor Juan Asensio explains that the book is an extension of four highly successful previous editions of another book published by Mosby, entitled Current Therapy of Trauma, last updated in 1998. Unlike its predecessors, this latest book addresses critical and rehabilitative care in addition to trauma. The table of contents is especially easy to follow. The book is meant to be a practical source of information that can be used to review a particular subject before entering the operating room or intensive care unit, or as a study guide in preparation for standardized testing. In this regard, less experienced clinicians will be somewhat at a disadvantage, because some fundamental background information on the pathophysiology of diseases is absent. In addition, the referencing and annotation standards vary. In some instances, the reader will be unable to identify the source of key statements, principles, and theories.

As one would expect from the title, Asensio and Trunkey's book provides a bit more specific and detailed review of elements of critical care, beyond those that result specifically from traumatic injury. It may be of particular interest to the trauma surgeon who is also an intensivist. For example, there are two major sections that address the management of organ failure and another section on special issues such as the acute respiratory distress syndrome, the systemic inflammatory response syndrome, sepsis, antibacterial therapies, and nutrition, as well as the important topic of grief and bereavement and the role of the surgeon. There is a well-constructed and updated chapter on nonoperative management of blunt and penetrating injury, although damage-control procedures are addressed in many different places in the book. The section describing the treatment of patients with duodenal injuries is also strong. The book also includes a short chapter on land mines and improvised explosive devices and introduces endovascular therapies. The use of flow charts in some sections to illustrate preferred treatment algorithms for managing specific diseases and conditions is welcome. However, as is often the case with multiauthored textbooks, the style and format of various sections are inconsistent. For example, some chapters include suggested readings and others do not, and some have summaries and specific conclusions to help organize the reading.

These drawbacks aside, however, the two books are incremental but notable additions to a somewhat crowded marketplace, and they are worthy of a place in surgical libraries.

Danny O. Jacobs, M.D., M.P.H.
Duke University Medical Center, Durham, NC 27710