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Predictors for Direct to Operating Room Admission in Severe Trauma.
Puzio, Thaddeus J; Love, Joseph D; McNutt, Michelle K; Stephens, Christopher T; Harvin, John A; Cabrera, Rudy; Kao, Lillian S; Cotton, Bryan A; Wade, Charles E; Meyer, David E.
Afiliação
  • Puzio TJ; Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas. Electronic address: thaddeus.j.puzio@uth.tmc.edu.
  • Love JD; Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas.
  • McNutt MK; Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas.
  • Stephens CT; Department of Anesthesiology, McGovern Medical School at UTHealth, Houston, Texas.
  • Harvin JA; Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas.
  • Cabrera R; Life Flight, Memorial Hermann Hospital, Texas Medical Center, Houston, Texas.
  • Kao LS; Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas.
  • Cotton BA; Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas.
  • Wade CE; Center for Translational Injury Research, Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas.
  • Meyer DE; Department of Surgery, McGovern Medical School at UTHealth, Houston, Texas; Life Flight, Memorial Hermann Hospital, Texas Medical Center, Houston, Texas.
J Surg Res ; 261: 274-281, 2021 05.
Article em En | MEDLINE | ID: mdl-33460973
ABSTRACT

BACKGROUND:

Protocols for expediting critical trauma patients directly from the helipad to the operating room tend to vary by center, rely heavily on physician gestalt, and lack supporting evidence. We evaluated a population of severely injured trauma patients with the aim of determining objective factors associated with the need for immediate surgical intervention.

METHODS:

All highest-activation trauma patients transported by air ambulance between 1/1/16 and 12/31/17 were enrolled retrospectively. Transfer, pediatric, isolated burn, and isolated head trauma patients were excluded. Patients who underwent emergency general surgery within 30 min of arrival without the aid of cross-sectional imaging were compared to the remainder of the cohort.

RESULTS:

Of the 863 patients who were enrolled, 85 (10%) spent less than 30 min in the emergency department (ED) before undergoing an emergency operation. The remaining 778 patients (90%) formed the comparison group. The ED ≤ 30 min group had a higher percentage of penetrating injuries, lower blood pressure, and was more likely to have a positive FAST exam. The "Direct to Operating Room" (DTOR) score is a predictive scoring system devised to identify patients most likely to benefit from bypassing the ED. The odds ratio of emergency operation within 30 min of hospital arrival increased by 2.71 (95% confidence interval 2.23-3.29; P < 0.001) for every 1-point increase in DTOR score.

CONCLUSIONS:

Trauma patients with profound hypotension or acidosis and positive FAST were more likely to require surgery within 30 min of hospital presentation. Use of a scoring system may allow early identification of these patients in the prehospital setting by nonphysician providers.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Admissão do Paciente / Centros de Traumatologia / Ferimentos e Lesões / Hemorragia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Admissão do Paciente / Centros de Traumatologia / Ferimentos e Lesões / Hemorragia Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2021 Tipo de documento: Article