K. Lynch1, P. Bonasso1, R. Whitehair1, A. Wilson1, D. Long1, J. Con1 1West Virginia University,Department Of Surgery,Morgantown, WV, USA
Introduction:
Resuscitative thoracotomy (RT) is an operation of last resort performed on moribund trauma patients. RT carries a risk of disease transmission and has a low survival rate, so the decision to attempt RT can be difficult. We hypothesize that disparities exist in RT attempt rates based on age and facility characteristics.
Methods:
The 2008-12 National Trauma Data Bank (NTDB) dataset was queried to identify patients who underwent open chest cardiac massage within one hour of arrival to the ED. Three groups were isolated: survived RT, died after RT, and died in the ED without RT. Patients were stratified by age and facility characteristics after adjusting for blunt or penetrating injury mechanism. Attempt rate was calculated by dividing RT attempts by all candidates for RT. We defined the survival rate as patients who survived RT divided by all those who underwent RT.
Results:
The overall RT attempt rate was 10.9% (18.1% penetrating, 6.3% blunt). Disparities in age stratified attempt rates were identified and are summarized in Table 1. RT survival was 5.5% (6.4% penetrating, 3.9% blunt), and no significant differences in age stratified survival rates were observed. RT attempt rates were higher at ACS Level 1 or 2 Trauma Centers, at university hospitals, at larger facilities, and certain regions in the country (Table 1). Increasing facility size correlated with improved RT survival after penetrating trauma.
Conclusion:
RT survival rates among elderly blunt trauma patients were similar to other age groups, yet attempt rates were significantly lower. This suggests a provider bias against this age group. For penetrating injuries, poor survival rates in the elderly were accompanied by appropriately low attempt rates. Attempt rates were higher at large university hospitals and at Level 1 or 2 Trauma Centers possibly because of the educational benefit of performing them. Further studies examining provider bias in patient selection for RT are needed.
