A. Barrett1, J. Hu1, W. Kelly1, D. Greenberg1, J. Lukan1 1State University Of New York At Buffalo, Surgery, Buffalo, NY, USA
Introduction:
Early identification of life-threatening injuries and appropriate trauma triaging is associated with reducing mortality and morbidity. The literature supports using lactate as an indicator for OR team activation on hospital arrival, however, there may be other predictors pre-hospital. We sought to identify whether trauma activation pages accurately predict OR activation and which additional physiologic factors exist to improve paging and OR activation accuracy.
Methods:
We conducted a 10-year retrospective review of the regional trauma database at Erie County Medical Center, a Level I trauma center, for penetrating thoracoabdominal gunshot wounds from 2009-2019. All trauma page 1 patients were identified and stratified into direct OR, CT to OR and survived vs. expired groups for direct OR. We excluded all dead-on arrival and walk in patients. Outcomes and patient characteristics were compared univariately using paired T tests.
Results:
217 Trauma level 1 patients (116 direct OR and 101 CT to OR) were identified. Direct trauma patients had a higher ISS (23.23 vs. 17.33 p<.001), lower SBP (98.79 vs. 131.2 mmHg p<.0001), and DBP (63.44 vs. 81.48mmHg p<.0001) blood pressures when compared to the CT group. Their GCS was also significantly lower in direct patients (10.54 vs. 13.88 p<.0001). Direct to OR patients were more acidotic as indicated by pH (7.24 vs. 7.33 p<.0001), ED CO2 (19.43 vs. 21.34 p<.001) and anion gap (17.4 vs. 12.15 p<.0001). INR for direct was higher than CT to OR (1.63 vs. 1.13 p<.05), indicating higher rates of coagulopathy. The mortality rate for Direct to OR is 38.79% compared to the CT group at 5.94%. 45 of the 116 direct OR patients died, yielding mortality rate of 38.8%.
Chest patients who died (n-28) had lower SBP (83.91 vs. 98.79 mmHg p<.05), lower DBP (28.28 vs. 57.4 mmHg p<.001), lower GCS (5.82 vs. 12.26 p<.0001) and lower heart rates at 83.91bpm vs. 115.65bpm p<.05). They were more acidotic (pH 7.04 vs. 7.21 p<.001) and more severely injured as indicated by ISS (38.79 vs. 26.1 p<.001). Abdominal patients who died (n=16) were more severely injured as indicated by ISS (22.56 vs. 13.38 p<.001), had lower SBP (72.36 vs. 125.81 mmHg p<.001) and DBP (50.36 vs. 82.8 mmHg 1 p<.001) blood pressures. They were more acidotic by pH (7.04 vs. 7.33), had larger base deficits (14.86 vs. 5.7 p<.001), higher ED CO2 (22.67 vs. 20.03 p<.01) and had a lower Sao2 (76 vs. 96.83 p<.001).
Conclusion:
We show that stratification of trauma 1 pages predicts different outcomes. Patients who went directly to OR had more physiologic abnormalities than CT patients. Development of early warning systems for trauma preparedness could be developed utilizing prehospital parameters. Effective prehospital evaluation and trauma team activation metrics need to be developed to accurately identify injury severity for proper trauma paging with possible OR not ED rescucitation for these patients.