E. E. Lee1,2, J. K. Canner2, L. Lam1, E. R. Haut2 2Johns Hopkins Bloomberg School Of Public Health,Center For Surgical Trials And Outcomes Research,Baltimore, MD, USA 1University Southern California,General Surgery,Los Angeles, CALIFORNIA, USA
Introduction:
Resuscitative thoracotomy (RT) remains a controversial procedure, with ongoing discussion about the benefits, salvage rates and potential risks. Despite published guidelines, there likely is wide variation in the use of this procedure. We sought to characterize nationwide variation in the use of this procedure.
Methods:
We performed a retrospective study using the National Trauma Data Bank (NTDB) from 2007-2014. We included all penetrating or blunt trauma patients who were potentially eligible for RT based on having all three of the following criteria: those presenting to the ED with a heart rate of 0, systolic blood pressure of 0, and a Glasgow Coma Scale motor score of 1. We examined variation between trauma centers in the institutional rates of RT. We identified factors associated with the odds of a patient receiving an RT. Statistical significance was predetermined as a p-value <0.05.
Results:
Of the 39,053 patients from 852 institutions, 4,143 (10.6%) underwent RT. Significant factors associated with a patient’s odds of receiving an RT included age, sex, race, injury severity, mechanism of injury, hospital trauma level designation, hospital teaching status, and region. Some hospital variation in the use of RT is related to patient characteristics. However, significant variation based on regional and institutional differences is also present.
Conclusion:
In order to ensure consistency in practices, standardization of indications for RT should be encouraged across the country.
