D. Meyer1, M. McNutt1, C. Stephens2, J. Harvin1, R. Cabrera4, L. Kao1, B. Cotton1,3, C. Wade3, J. Love1 1McGovern Medical School at UTHealth,Acute Care Surgery/Surgery/McGovern Medical School,Houston, TX, USA 2McGovern Medical School at UTHealth,Trauma Anesthesiology/Anesthesiology/McGovern Medical School,Houston, TX, USA 3McGovern Medical School at UTHealth,Center For Translational Injury Research/Surgery/McGovern Medical School,Houston, TX, USA 4Memorial Hermann Hospital,LifeFlight,Houston, TX, USA
Introduction: Many trauma centers utilize protocols for expediting critical trauma patients directly from the helipad to the OR. Used judiciously, bypassing the ED can decrease resource utilization and the time to definitive hemorrhage control. However, criteria vary by center, rely heavily on physician gestalt, and lack evidence to support their use. With prehospital ultrasound and base excess increasingly available, opportunities may exist to identify risk factors for emergency surgery in severe trauma.
Methods: All highest-activation trauma patients transported by air ambulance between 1/1/16 and 7/30/17 were included retrospectively. Transfer, CPR, and isolated head trauma patients were excluded. Patients were dichotomized into two groups based on ED time: those spending <30min who underwent emergency surgery by the trauma team and those spending >60min. Prehospital and ED triage data were used to calculate univariable and multivariable odds ratios.
Results: 435 patients met enrollment criteria over the study period. 76 (17%) spent <30min in the ED before undergoing emergency surgery (median age 31y [21-45], 82% male, 41% penetrating). 359 (83%) patients spent >60min (median age 35y [21-48], 74% male, 15% penetrating). HR, SBP, and BE values were similar in the two groups. Mortality was higher in <30min (32% vs 9%, p<0.001). Compared to >60min, the <30min group was more likely to have: (1) penetrating trauma with SBP<80mmHg or BE<-16 (OR 15.02, 95% CI 4.64-48.61); (2) penetrating trauma with positive FAST (OR 27.54, 95% CI 9.00-84.28); or (3) blunt trauma with a positive FAST and SBP<80mmHg or BE<-10 (OR 11.98, 95% CI 4.03-35.63). Collectively, these criteria predicted 39 (51%) of the <30min group.
Conclusion: Both blunt and penetrating trauma patients with positive FAST and profound hypotension or acidosis were much more likely to require emergency surgery within 30 minutes of hospital presentation and may not benefit from time spent in the emergency department.
