Introducing: Challenges in acute care surgery

C onsidering the explosion of complex, scientifically-based data published each month in the Journal of Trauma and Acute Care Surgery, we thought it would be refreshing to provide a concise overview of a management dilemma in acute care surgery. To that end, we are pleased to announce the launch of a new quiz-based feature known as the ‘‘Acute Care Surgery (ACS) Challenge.’’ These articles will be found at the end of each issue; the debut articleVcommissioned and completed in house, just in case we botched itVcan be found in this issue on page 703. The fundamental design of this article is meant to initially convey enough diagnostic information to generate a list of plausible therapeutic options, while recognizing that treatment choices may be institutionor resource-specific. The first page opens with a short clinical vignette, which is followed by a set of therapeutic options under the heading ‘‘What would you do?’’ The second page summarizes the authors’ management of a case before offering a brief critique written by another recognized expert in that arena. Essentially, the piece functions as both quiz and catalyst for discussion across institutions. Surgical decision making is an inherently dynamic process that largely depends on a heady mix of experience, abductive reasoning, and evidence for best results, and we expect reader reactions to the vignettes, management options, and expert opinion to vary. It is important to keep in mind that the decisions and critique are essentially opinions and, as such, are not intended to imply the optimal management. While the format may be viewed as more entertainment than education, the selected topics will represent present-day controversies. Thus, these actual patient scenarios may serve as an introduction to the formal presentation of a topic or stimulate clinical investigation to ultimately provide the correct solution. On a practical note, we will accept submissions to the ACS Challenge on an open basis. However, we only intend to publish one quiz each month. Prospective authors may consult our instructions for more detail, but generally we expect that submissions to follow a set template: opening with a short gloss on a clinical scenario, detailing four possible management options (the answers to ‘‘What would you do?’’), and closing with another brief description of what was actually performed. If the editors are interested in proceeding with a particular ACS Challenge, an expert commentary will be commissioned by the editorial office. We ask that the ACS Challenge contain no references and up to three figures. If you have any questions, please contact the editorial office any time. As always, we welcome both your submissions to this new addition to the Journal and your suggestions to improve its value. EDITORIAL