Details

Autor(en) / Beteiligte

• Barbosa, Ronald R
• Rowell, Susan E
• Fox, Erin E
• Holcomb, John B
• Bulger, Eileen M
• Phelan, Herbert A
• Alarcon, Louis H
• Myers, John G
• Brasel, Karen J
• Muskat, Peter
• del Junco, Deborah J
• Cotton, Bryan A
• Wade, Charles E
• Rahbar, Mohammad H
• Cohen, Mitchell J
• Schreiber, Martin A

Titel

Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy

Ist Teil von

• The journal of trauma and acute care surgery, 2013-07, Vol.75 (1 Suppl 1), p.S48-S52

Ort / Verlag

United States

Erscheinungsjahr

2013

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Focused assessment with sonography for trauma (FAST) is commonly used to facilitate the timely diagnosis of life-threatening hemorrhage in injured patients. Most patients with positive findings on FAST require laparotomy. Although it is assumed that an increasing time to operation (T-OR) leads to higher mortality, this relationship has not been quantified. This study sought to determine the impact of T-OR on survival in patients with a positive FAST who required emergent laparotomy. We retrospectively analyzed patients from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study who underwent laparotomy within 90 minutes of presentation and had a FAST performed. Cox proportional hazards models including Injury Severity Score (ISS), age, base deficit, and hospital site were created to examine the impact of increasing T-OR on in-hospital survival at 24 hours and 30 days. The impact of time from the performance of the FAST examination to operation (TFAST-OR) on in-hospital mortality was also examined using the same model. One hundred fifteen patients met study criteria and had complete data. Increasing T-OR was associated with increased in-hospital mortality at 24 hours (hazard ratio [HR], 1.50 for each 10-minute increase in T-OR; confidence interval [CI], 1.14-1.97; p = 0.003) and 30 days (HR, 1.41; CI, 1.18-2.10; p = 0.002). Increasing TFAST-OR was also associated with higher in-hospital mortality at 24 hours (HR, 1.34; CI, 1.03-1.72; p = 0.03) and 30 days (HR, 1.40; CI, 1.06-1.84; p = 0.02). In patients with a positive FAST who required emergent laparotomy, delay in operation was associated with increased early and late in-hospital mortality. Delays in T-OR in trauma patients with a positive FAST should be minimized.