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المؤلفون: Rebecca Badminton, Rebekka Troller, Bryony Roberts, David O’Reilly, Nick Moody, Emma Davies, Michael Thompson, Mihir Chandarana, Gary Maytham, Zane Perkins, Paul Vulliamy, Duncan Bew, Somayyeh Mossadegh, Iain M. Smith, Charles Bull, Michael Smith, Kirsty Challen, Gethin L. Williams, Helen Farrah, Jonathan Jones, Lorcan o Maoileannaigh, Stella Ruth Smith, Disha Mehta, Victoria Pegna, Adam Brooks, Harriet Owen, Anthony Thaventhiran, Ben Stubbs, Anna Sharrock, Kate Hancorn, Tony Sim, Johanna Paterson, Henry Obinna Nnajiuba, Seema Yalamanchili, Anitha Muthusami, David N. Naumann, Ben Griffiths, Ian Bailey, Jo Manson, Michael Wilson, Harsha Kodakadath, Ross Davenport, Maryam Alfa-Wali, Francis Ezidi, Charlotte Thompson, Olga Rutka, Kate Rej. Prior, Christine Hardcastle, Ewen A. Griffiths, Ibrahim Enemosah, Parv Sains, Charlotte Florence, Sam Docherty, Laura Evans, Max Marsden, Giles Bond-Smith, Chris Finnegan, Stavros Gourgiotis, Adam Gowdy, Natesh Shivakumar, Helen R Dorrance, Lewis S. Gall, Alexandra Chesworth, Raimundas Lunevicius, Michael Greenway, Adeel Akhtar, Oliver Harrison, Callum T. Kaye, Mark Winstanley, Lauren Blackburn, Maria Bassett-Davies, Colin Bergin, Stuart McKechnie, Christopher Briggs, Joseph Hardwicke, Daniel McGeown, Charles A. West, Jon Moore, Alexander Bell, Julian Thompson, Paul Farrelly, Amar Kourdouli, Andrea Rossetto, Phillip Pearce, Nicola Lipscombe, Una Cronin, Alice Graham, Rebecca Varley, Elizabeth Vaughan, Jennifer Ross, Esau Moreno-Camacho, Mari-Claire McGuigan, Jack Navein, Emma Stewart Parker, Alan Watts, Ashish Shrestha, Mansoor Khan, Rich Carden, Laura Jayne Watson, Nabeela S. Malik, Nigel Tai, Michael Daley, Tom Cowlam
المصدر: Journal of the American College of Surgeons. 233:383-394
مصطلحات موضوعية: 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
الوصف: 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.
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