Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy. J Trauma Acute Care Surg 2013 Jul;75(1 Suppl 1):S48-52
Date
08/15/2013Pubmed ID
23778511Pubmed Central ID
PMC3744056DOI
10.1097/TA.0b013e31828fa54eScopus ID
2-s2.0-84880418699 (requires institutional sign-in at Scopus site) 71 CitationsAbstract
INTRODUCTION: Focused assessment with sonography for trauma (FAST) is commonly used to facilitate the timely diagnosis of life-threatening hemorrhage in injured patients. Most patients with positive findings on FAST require laparotomy. Although it is assumed that an increasing time to operation (T-OR) leads to higher mortality, this relationship has not been quantified. This study sought to determine the impact of T-OR on survival in patients with a positive FAST who required emergent laparotomy.
METHODS: We retrospectively analyzed patients from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study who underwent laparotomy within 90 minutes of presentation and had a FAST performed. Cox proportional hazards models including Injury Severity Score (ISS), age, base deficit, and hospital site were created to examine the impact of increasing T-OR on in-hospital survival at 24 hours and 30 days. The impact of time from the performance of the FAST examination to operation (TFAST-OR) on in-hospital mortality was also examined using the same model.
RESULTS: One hundred fifteen patients met study criteria and had complete data. Increasing T-OR was associated with increased in-hospital mortality at 24 hours (hazard ratio [HR], 1.50 for each 10-minute increase in T-OR; confidence interval [CI], 1.14-1.97; p = 0.003) and 30 days (HR, 1.41; CI, 1.18-2.10; p = 0.002). Increasing TFAST-OR was also associated with higher in-hospital mortality at 24 hours (HR, 1.34; CI, 1.03-1.72; p = 0.03) and 30 days (HR, 1.40; CI, 1.06-1.84; p = 0.02).
CONCLUSION: In patients with a positive FAST who required emergent laparotomy, delay in operation was associated with increased early and late in-hospital mortality. Delays in T-OR in trauma patients with a positive FAST should be minimized.
Author List
Barbosa RR, Rowell SE, Fox EE, Holcomb JB, Bulger EM, Phelan HA, Alarcon LH, Myers JG, Brasel KJ, Muskat P, del Junco DJ, Cotton BA, Wade CE, Rahbar MH, Cohen MJ, Schreiber MA, PROMMTT Study GroupMESH terms used to index this publication - Major topics in bold
AdultBlood Transfusion
Female
Hemorrhage
Hospital Mortality
Humans
Injury Severity Score
Male
Middle Aged
Proportional Hazards Models
Resuscitation
Retrospective Studies
Survival Rate
Time Factors
Trauma Centers
Treatment Outcome
Ultrasonography
United States
Wounds and Injuries
