Outcomes by time-to-OR for penetrating abdominal trauma patients.
Am J Emerg Med
; 79: 144-151, 2024 05.
Article
em En
| MEDLINE
| ID: mdl-38432154
ABSTRACT
INTRODUCTION:
Time-To-OR is a critical process measure for trauma performance. However, this measure has not consistently demonstrated improvement in outcome. STUDYDESIGN:
Using TQIP, we identified facilities by 75th percentile time-to-OR to categorize slow, average, and fast hospitals. Using a GEE model, we calculated odds of mortality for all penetrating abdominal trauma patients, firearm injuries only, and patients with major complication by facility speed. We additionally estimated odds of mortality at the patient level.RESULTS:
Odds of mortality for patients at slow facilities was 1.095; 95% CI 0.746, 1.608; p = 0.64 compared to average. Fast facility OR = 0.941; 95% CI 0.780, 1.133; p = 0.52. At the patient-level each additional minute of time-to-OR was associated with 1.5% decreased odds of in-hospital mortality (OR 0.985; 95% CI0.981, 0.989; p < 0.001). For firearm-only patients, facility speed was not associated with odds of in-hospital mortality (p-value = 0.61). Person-level time-to-OR was associated with 1.8% decreased odds of in-hospital mortality (OR 0.982; 95% CI 0.977, 0.987; p < 0.001) with each additional minute of time-to-OR. Similarly, failure-to-rescue analysis showed no difference in in-hospital mortality at the patient level (p = 0.62) and 0.4% decreased odds of in-hospital mortality with each additional minute of time-to-OR at the patient level (OR 0.996; 95% CI 0.993, 0.999; p = 0.004).CONCLUSION:
Despite the use of time-to-OR as a metric of trauma performance, there is little evidence for improvement in mortality or complication rate with improved time-to-OR at the facility or patient level. Performance metrics for trauma should be developed that more appropriately approximate patient outcome.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ferimentos por Arma de Fogo
/
Ferimentos Penetrantes
/
Armas de Fogo
/
Traumatismos Abdominais
Limite:
Humans
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article