The new timing in acute care surgery (new TACS) classification: a WSES Delphi consensus study.

Autor: De Simone B; Department of General and Emergency Surgery, Guastalla Hospital, AUSL Reggio Emilia, Guastalla, Italy. desimone.belinda@gmail.com.; Unit of General and Metabolic Surgery, Clinique de St Louis, Poissy, France. desimone.belinda@gmail.com., Kluger Y; Department of General Surgery, The Rambam Academic Hospital, Haifa, Israel., Moore EE; Ernest E. Moore Shock Trauma Center, University of Colorado, Denver, USA., Sartelli M; Department of General Surgery, Macerata Hospital, Macerata, Italy., Abu-Zidan FM; The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates., Coccolini F; Department of General and Trauma Surgery, University Hospital of Pisa, Pisa, Italy., Ansaloni L; Department of General Surgery, University Hospital of Pavia, Pavia, Italy., Tebala GD; U.O.C. Chirurgia Digestiva e d'Urgenza, Azienda Ospedaliera S.Maria, Terni, Italy., Di Saverio S; Department of General Surgery, Santa Maria del Soccorso Hospital, San Benedetto del Tronto, Ascoli Piceno, Italy., Di Carlo I; Department of Surgical Sciences and Advanced Technologies, University of Catania, Cannizzaro Hospital, Catania, Italy., Sakakushev BE; Research Institute at Medical University Plovdiv/University Hospital St George, Plovdiv, Bulgaria., Bonavina L; Division of General and Foregut Surgery, University of Milan, IRCCS Policlinico San Donato, Milan, Italy., Sugrue M; Donegal Clinical Research Academy, Letterkenny University Hospital, Letterkenny, Ireland., Galante JM; Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA., Ivatury R; Virginia Commonwealth University, Richmond, VA, USA., Picetti E; Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy., Chirica M; Department of Digestive Surgery, Centre Hospitalier Universitaire Grenoble Alpes, La Tronche, France., Wani I; Government Gousia Hospital, Srinagar, India., Bala M; Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel., Sall I; General Surgery Department, Military Teaching Hospital, Dakar, Senegal., Kirkpatrick AW; General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, AB, Canada., Shelat VG; Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore., Pikoulis E; Medical School, National and Kapodistrian University of Athens, (NKUA), Athens, Greece., Leppäniemi A; Abdominal Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland., Tan E; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Broek RPGT; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Gurmu Beka S; Department of General and Trauma Surgery, Ethiopian Air Force Hospital, Bishoftu, Ethiopia. sologbeka@gmail.com., Litvin A; Department of Surgical Disciplines, Regional Clinical Hospital, Immanuel Kant Baltic Federal University, Kaliningrad, Russia., Chouillard E; Unit of General and Metabolic Surgery, Clinique de St Louis, Poissy, France., Coimbra R; CECORC Research Center, Riverside University Health System, Loma Linda University, Loma Linda, USA., Cui Y; Department of Surgery, Nankai Clinical School of Medicine, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China., De' Angelis N; Colorectal and Digestive Surgery Unit - DIGEST Department, Beaujon University Hospital (AP-HP), Clichy, France., Sganga G; Department of Emergency Surgery, 'A. Gemelli Hospital', Catholic University of Rome, Rome, Italy., Stahel PF; Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, USA., Agnoletti V; Level I Trauma Centre, Bufalini Hospital, Cesena, Italy., Rampini A; Department of General and Emergency Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, Italy., Testini M; Department of Surgery, University Hospital of Bari, Bari, Italy., Bravi F; Healthcare Administration, Santa Maria Delle Croci Hospital, AUSL Romagna, Ravenna, Italy., Maier RV; Harborview Medical Center, University of Washington, Seattle, WA, USA., Biffl WL; Department of Emergency and Trauma Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA., Catena F; Department of General Surgery, Level I Trauma Center, Bufalini Hospital, Cesena, eCampus University, CREAS, Ser.In.Ar. Bologna University, Cesena, Italy.
Jazyk: angličtina
Zdroj: World journal of emergency surgery : WJES [World J Emerg Surg] 2023 Apr 28; Vol. 18 (1), pp. 32. Date of Electronic Publication: 2023 Apr 28.
DOI: 10.1186/s13017-023-00499-3
Abstrakt: Background: Timely access to the operating room for emergency general surgery (EGS) indications remains a challenge across the globe, largely driven by operating room availability and staffing constraints. The "timing in acute care surgery" (TACS) classification was previously published to introduce a new tool to triage the timely and appropriate access of EGS patients to the operating room. However, the clinical and operational effectiveness of the TACS classification has not been investigated in subsequent validation studies. This study aimed to improve the TACS classification and provide further consensus around the appropriate use of the new TACS classification through a standardized Delphi approach with international experts.
Methods: This is a validation study of the new TACS by a selected international panel of experts using the Delphi method. The TACS questionnaire was designed as a web-based survey. The consensus agreement level was established to be ≥ 75%. The collective consensus agreement was defined as the sum of the percentage of the highest Likert scale levels (4-5) out of all participants. Surgical emergency diseases and correlated clinical scenarios were defined for each of the proposed classes. Subsequent rounds were carried out until a definitive level of consensus was reached. Frequencies and percentages were calculated to determine the degree of agreement for each surgical disease.
Results: Four polling rounds were carried out. The new TACS classification provides 6 colour-code classes correlated to a precise timing to surgery, defined scenarios and surgical condition. The WHITE colour-code class was introduced to rapidly (within a week) reschedule cancelled or postponed surgical procedures. Haemodynamic stability is the main tool to stratify patients for immediate surgery or not in the presence of sepsis/septic shock. Fifty-one surgical diseases were included in the different colour-code classes of priority.
Conclusion: The new TACS classification is a comprehensive, simple, clear and reproducible triage system which can be used to assess the severity of the patient and the surgical disease, to reduce the time to access to the operating room, and to manage the emergency surgical patients within a "safe" timeframe. By including well-defined surgical diseases in the different colour-code classes of priority, validated through a Delphi consensus, the new TACS improves communication among surgeons, between surgeons and anaesthesiologists and decreases conflicts and waste and waiting time in accessing the operating room for emergency surgical patients.
(© 2023. The Author(s).)
Databáze: MEDLINE
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