Trauma Laparotomy in the UK: A Prospective National Service Evaluation.
Journal
Journal of the American College of Surgeons
ISSN: 1879-1190
Titre abrégé: J Am Coll Surg
Pays: United States
ID NLM: 9431305
Informations de publication
Date de publication:
09 2021
09 2021
Historique:
received:
24
04
2021
accepted:
26
04
2021
pubmed:
21
5
2021
medline:
12
11
2021
entrez:
20
5
2021
Statut:
ppublish
Résumé
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. 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. 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 < 0.001). 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.
Sections du résumé
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 < 0.001).
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.
Identifiants
pubmed: 34015456
pii: S1072-7515(21)00361-6
doi: 10.1016/j.jamcollsurg.2021.04.031
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
383-394.e1Investigateurs
Henry Obinna Nnajiuba
(HO)
Zane Perkins
(Z)
Phillip Pearce
(P)
Seema Yalamanchili
(S)
Nabeela S Malik
(NS)
Nigel Tai
(N)
Tony Sim
(T)
Callum T Kaye
(CT)
Stavros Gourgiotis
(S)
Raimundas Lunevicius
(R)
Adeel Akhtar
(A)
Chris Finnegan
(C)
Francis Ezidi
(F)
Daniel McGeown
(D)
Adam Gowdy
(A)
Parv Sains
(P)
Charles Bull
(C)
Victoria Pegna
(V)
Charlotte Florence
(C)
David O'Reilly
(D)
Bryony Roberts
(B)
Emma Davies
(E)
Maria Bassett-Davies
(M)
Joseph Hardwicke
(J)
Michael Smith
(M)
Christopher Briggs
(C)
Somayyeh Mossadegh
(S)
Ibrahim Enemosah
(I)
Ben Stubbs
(B)
Charles West
(C)
Michael Wilson
(M)
Elizabeth Vaughan
(E)
Stuart McKechnie
(S)
Alice Graham
(A)
Mihir Chandarana
(M)
Helen Dorrance
(H)
Lewis Gall
(L)
Mari-Claire McGuigan
(MC)
Tom Cowlam
(T)
Alexander Bell
(A)
Christine Hardcastle
(C)
Duncan Bew
(D)
Kate Rej Prior
(KR)
Mark Winstanley
(M)
Jon Moore
(J)
Emma Stewart Parker
(ES)
Jonathan Jones
(J)
Stella Ruth Smith
(SR)
Rebecca Varley
(R)
Johanna Paterson
(J)
Laura Evans
(L)
Nicola Lipscombe
(N)
Ben Griffiths
(B)
Laura Jayne Watson
(LJ)
Adam Brooks
(A)
Nick Moody
(N)
Amar Kourdouli
(A)
Lauren Blackburn
(L)
Giles Bond-Smith
(G)
Anitha Muthusami
(A)
Natesh Shivakumar
(N)
Ewen A Griffiths
(EA)
Colin Bergin
(C)
Kirsty Challen
(K)
Michael Daley
(M)
Iain M Smith
(IM)
Gethin L Williams
(GL)
Olga Rutka
(O)
Jennifer Ross
(J)
Anthony J Thaventhiran
(AJ)
Kate Hancorn
(K)
Andrea Rossetto
(A)
Rebecca Badminton
(R)
Esau Moreno-Camacho
(E)
Paul Farrelly
(P)
Oliver Harrison
(O)
Gary Maytham
(G)
Maryam Alfa-Wali
(M)
Helen Farrah
(H)
Harriet Owen
(H)
Jack Navein
(J)
Harsha Kodakadath
(H)
Mansoor Khan
(M)
Rebekka Troller
(R)
Julian Thompson
(J)
Michael Thompson
(M)
Charlotte Thompson
(C)
Ian Bailey
(I)
Jo Manson
(J)
Anna Sharrock
(A)
Michael Greenway
(M)
Alexandra Chesworth
(A)
Ashish Shrestha
(A)
Disha Mehta
(D)
Alan Watts
(A)
Una Cronin
(U)
Lorcan O Maoileannaigh
(LO)
Sam Docherty
(S)
Commentaires et corrections
Type : CommentIn
Informations de copyright
Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.