Portal de Periódicos da CAPES

A decade of experience with a selective policy for direct to operating room trauma resuscitations

2012; Elsevier BV; Volume: 204; Issue: 2 Linguagem: Inglês

10.1016/j.amjsurg.2012.06.001

1879-1883

Matthew J. Martin, Seth Izenberg, Frederick Cole, Sue Bergstrom, William B. Long,

Cardiac Arrest and Resuscitation

Abstract Background 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. Methods 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. Results 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), GCS <9 (odds ratio=1.9), and hypotension (odds ratio=1.8). Discussion 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.