Journal article
Surgical stabilization of critical abdominal injuries in a mature rural trauma system: A retrospective study
The journal of trauma and acute care surgery, Vol.94(2), pp.248-257
02/2023
DOI: 10.1097/TA.0000000000003841
Abstract
BACKGROUND
Worse outcomes following injuries are more likely in rural versus urban areas. In 2001, our state established an inclusive trauma system to improve mortality. In 2015, the trauma system had a consultation visit from the American College of Surgeons' Committee on Trauma, who made several recommendations. We hypothesized that continued maturation of this system would lead to more laparotomies prior to transfer to a higher level of care and better outcomes.
METHODS
Our trauma registry was queried to identify all patients transferred between January 1, 2010, and December 31, 2020, who underwent laparotomy either before transfer or within 4 hours of arrival. The preconsultation (2010–2015) and postconsultation periods (2016–2020) were compared. Categorical and continuous variables were compared using χ2 and Mann-Whitney U tests, respectively.
RESULTS
We included 213 patients; 63 had laparotomy before transfer and 150 within 4 hours after transfer. Age, injury severity scores, systolic blood pressure, and mechanism of injury were not different between periods. Proportions of laparotomy before and after transfer and outcomes (mortality, hospital length of stay, intensive care unit length of stay, ventilator days) were also similar (p = 0.368 for laparotomy, p = 0.840, 0.124, 0.286, 0.822 for outcomes). Compared with the preconsultation period, the proportion of laparotomy performed before transfer for severe injuries (abdominal Abbreviated Injury Scale score >3) significantly increased postconsultation (57.1% vs. 30.6%, p = 0.011). Incidence of damage-control laparotomies (43.9% vs. 23.6%; p = 0.020) and transfusion of plasma and platelets (33.6% vs. 13.2%; p < 0.001, 22.4% vs. 8.5%, p = 0.007, respectively) significantly increased.
CONCLUSION
Identification and surgical stabilization of critical patients at the non-Level I facilities prior to transfer, as well as blood product use and damage-control techniques, improved postconsultation, suggesting a shift in the approaches to surgical stabilization and resuscitation efforts in our trauma system.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
Details
- Title: Subtitle
- Surgical stabilization of critical abdominal injuries in a mature rural trauma system: A retrospective study
- Creators
- Chandler TinsmanMichele LilienthalColette GaletJames TornerDionne A. Skeete
- Resource Type
- Journal article
- Publication Details
- The journal of trauma and acute care surgery, Vol.94(2), pp.248-257
- DOI
- 10.1097/TA.0000000000003841
- ISSN
- 2163-0755
- eISSN
- 2163-0763
- Language
- English
- Date published
- 02/2023
- Academic Unit
- Neurology; Epidemiology; Surgery; Injury Prevention Research Center; Neurosurgery
- Record Identifier
- 9984361596202771
Metrics
21 Record Views