A decade of experience with a selective policy for direct to operating room trauma resuscitations
| Autor: | Seth Izenberg, Matthew J. Martin, Sue Bergstrom, William B. Long, Frederick Cole |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Resuscitation Operating Rooms Time Factors Traumatology Oregon Injury Severity Score Patient Admission Trauma Centers medicine Humans Glasgow Coma Scale Intensive care medicine Retrospective Studies business.industry Retrospective cohort study General Medicine Emergency department Triage Organizational Policy Logistic Models Chest Tubes Surgical Procedures Operative Emergency medicine Golden hour (medicine) Wounds and Injuries Surgery Female Hypotension business |
| Zdroj: | American journal of surgery. 204(2) |
| ISSN: | 1879-1883 |
| Popis: | The standard paradigm for acutely injured patients involves evaluation in an emergency department (ED). Our center has employed a policy for bypassing the ED and proceeding directly to the operating room (OR) based on prehospital criteria.This is a retrospective analysis of all trauma patients admitted "direct to OR" (DOR) over 10 years. Demographics, injury patterns, prehospital, and in-hospital data were analyzed.There were 1,407 patients admitted as DOR resuscitations. Almost half (47%) had a penetrating mechanism, and 54% had chest or abdominal injury. The mean Injury Severity Score was 19, with altered mentation (Glasgow coma score [GCS]9) in 20% and hypotension in 16%. Most patients (68%) required surgical intervention, and 33% required emergency surgery operations (abdominal [70%] followed by thoracic [22%] and vascular [4%]). The median time to intervention was 13 minutes. Mortality was significantly lower than predicted (5% vs 10%). Independent predictors of emergent surgical intervention were a penetrating truncal injury (odds ratio = 9.9), GCS9 (odds ratio = 1.9), and hypotension (odds ratio = 1.8).Our DOR protocol identified a severely injured cohort at high risk for requiring surgery with improved observed survival. High-yield triage criteria for DOR admission include a penetrating truncal injury, hypotension, and a severely altered mental status. |
| Databáze: | OpenAIRE |
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