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Trauma Laparotomy in the UK: A Prospective National Service Evaluation
- Source :
- Journal of the American College of Surgeons. 233:383-394
- Publication Year :
- 2021
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2021.
-
Abstract
- Background Trauma patients requiring abdominal operation have considerable morbidity and mortality, yet no specific quality indicators are measured in the trauma systems of the UK. The aims of this study were to describe the characteristics and outcomes of patients undergoing emergency abdominal operation and key processes of care. Study Design A prospective multicenter service evaluation was conducted within all of the major trauma centers in the UK. The study was conducted during 6 months beginning in January 2019. Patients of any age undergoing laparotomy or laparoscopy within 24 hours of injury were included. Existing standards for related emergent conditions were used. Results The study included 363 patients from 34 hospitals. The majority were young men with no comorbidities who required operation to control bleeding (51%). More than 90% received attending-delivered care in the emergency department (318 of 363) and operating room (321 of 363). The overall mortality rate was 9%. Patients with blunt trauma had a greater risk of death compared with patients with penetrating injuries (16.6% vs 3.8%; risk ratio 4.3; 95% CI, 2.0 to 9.4). Patients in which the Major Hemorrhage Protocol (MHP) was activated and who received a blood transfusion (n = 154) constituted a high-risk subgroup, accounting for 45% of the study cohort but 97% of deaths and 96% of blood components transfused. The MHP subgroup had expedited timelines from emergency department arrival to knife to skin (MHP: median 119 minutes [interquartile range 64 to 218 minutes] vs no MHP: median 211 minutes [interquartile range 135 to 425 minutes]; p Conclusions The majority of trauma patients requiring emergency abdominal operation received a high standard of expedited care in a maturing national trauma system. Despite this, mortality and resource use among high-risk patients remains considerable.
- Subjects :
- Adult
Male
medicine.medical_specialty
Blood transfusion
medicine.medical_treatment
Abdominal Injuries
03 medical and health sciences
0302 clinical medicine
Trauma Centers
Interquartile range
Laparotomy
medicine
Humans
Prospective Studies
Quality Indicators, Health Care
business.industry
Major trauma
Mortality rate
Emergency department
Middle Aged
medicine.disease
United Kingdom
Blunt trauma
030220 oncology & carcinogenesis
Emergency medicine
Injury Severity Score
Female
030211 gastroenterology & hepatology
Surgery
Emergencies
business
Subjects
Details
- ISSN :
- 10727515
- Volume :
- 233
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Surgeons
- Accession number :
- edsair.doi.dedup.....9f2175941565ed52fadb5a4066409bcb