World J Surg 2000,24(1):114–118. PubMed: 10594214PubMedCrossRef 8. Cleary RK, Pomerantz RA, Lampman RM: Colon and rectal injuries. Dis Colon and Rectum 2006,49(8):1203–1222. PubMed: 16858663CrossRef Selleck Cediranib 9. Navsaria PH, Edu S, Nicol AJ: Civilian extraperitoneal rectal gunshot wounds: surgical management made simpler. World J Surg 2007,31(6):1345–1351. PubMed: 17457641PubMedCrossRef

10. Burch MD JM, Feliciano MD DV, Mattox MD KL: Colostomy and drainage for civilian rectal injuries: is that all? Ann Surg 1989,209(5):600–610. discussion 610–1CrossRef 11. Gonzalez RP, Falimirski ME, Holevar MR: The role of presacral drainage in the management of penetrating rectal injuries. J Trauma 1998,45(4):656–661. PubMed: 9783600PubMedCrossRef 12. Armstrong RG, Schmitt HJ Jr, Patterson LT: Combat wounds of the extraperitoneal rectum. Surgery 1973, 74:570–574. PubMed: 4729222PubMed 13. Gonzalez RP, Phelan H 3rd, Hassan M, Ellis CN, Rodning CB: Is fecal diversion necessary for nondestructive penetrating extraperitoneal rectal injuries ? J Trauma 2006,61(4):815–819.PubMedCrossRef HM781-36B manufacturer 14. Burch JM, Feliciano DV, Mattox KL: Colostomy and drainage for civilian rectal injuries: is that all? Ann Surg 1989,209(5):600–610.PubMedCrossRef 15. Ivatury RR, Licata J, Gunduz Y, Rao P, Stahl

WM: Management options in penetrating rectal injuries. Am Surg 1991,57(1):50–55.PubMed Competing interests All authors declare no competing interests. Authors’ contributions KIM and SA participated in writing

the case report and revising the draft, IT took the photos E B and KM participated in the follow up. All authors read and approved the final manuscript.”
“Introduction Trauma is the most common cause of death in Canada for the age group of 44 years or less. In 2004, intentional and unintentional injuries led to 13,677 deaths, and 211,000 hospitalizations [1]. The economic burden from injuries is estimated at $10.7 billion in health care costs, and $19.8 billion in total economic costs [1]. Trauma resuscitations often involve complex decision-making and management of critical injuries in Carbohydrate a short span of time. Errors are common; an Australian study on trauma management found 6.09 errors per fatal case in the emergency department (ED) with 3.47 errors contributing to patient death [2]. Since 1977, the Advanced Trauma Life Support (ATLS) treatment paradigm was established to improve the management of trauma patients during the initial resuscitation phase [3]. ATLS protocols provide a common framework and organized approach during these situations, and have been shown to improve outcomes [4, 5]. Unfortunately, attrition rate of ATLS knowledge [6, 7] and low compliance rate are issues even in major trauma centers. Deviations from ATLS protocols are common, ranging from 23% to 53% [8–11]. Compliance rate can affect patient outcome [4, 5], and can serve as a surrogate marker for quality assessment of a trauma BYL719 system.