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Impact of time to surgery on mortality in hypotensive patients with noncompressible torso hemorrhage: An AAST multicenter, prospective study. | LitMetric
From the Tulane University School of Medicine (J.D., K.S., D.T.), New Orleans, Louisiana; Broward Health Medical Center (I.P., J.D.B.), Fort Lauderdale; University of Florida-Jacksonville (B.Y., J.M.), Jacksonville, Florida; University of Pittsburgh (J.S., M.T.), Pittsburgh, Pennsylvania; UC San Diego Medical Center (T.C., A.E.B.), San Diego, California; University of Kentucky Chandler Medical Center (T.K., G.R.), Lexington, Kentucky; University of Texas Health Tyler (S.N., K.M.), Tyler, Texas; Mount Sinai Hospital (G.C., B.M.L.), Chicago, Illinois; Our Lady of the Lake Regional Medical Center (T.J.), Baton Rouge, Louisiana; University of New Mexico Hospital (L.V.S., J.P.), Albuquerque, New Mexico; Temple University Hospital (Z.M., A.J.G.), Philadelphia, Pennsylvania; St. Anthony Hospital (R.M.M., G.P.), Lakewood, Colorado; Research Medical Center (M.J.L.), Kansas City, Missouri; Ascension Via Christi Hospital St. Francis (J.H.), Wichita, Kansas; and Medical City Plano (G.M., M.C.), Plano, Texas.
Published: May 2022
AI Article Synopsis
Article Abstract
Background: Death from noncompressible torso hemorrhage (NCTH) may be preventable with improved prehospital care and shorter in-hospital times to hemorrhage control. We hypothesized that shorter times to surgical intervention for hemorrhage control would decrease mortality in hypotensive patients with NCTH.
Methods: This was an AAST-sponsored multicenter, prospective analysis of hypotensive patients aged 15+ years who presented with NCTH from May 2018 to December 2020. Hypotension was defined as an initial systolic blood pressure (SBP) ≤ 90 mm Hg. Primary outcomes of interest were time to surgical intervention and in-hospital mortality.
Results: There were 242 hypotensive patients, of which 48 died (19.8%). Nonsurvivors had higher mean age (47.3 vs. 38.8; p = 0.02), higher mean New Injury Severity Score (38 vs. 29; p < 0.001), lower admit systolic blood pressure (68 vs. 79 mm Hg; p < 0.01), higher incidence of vascular injury (41.7% vs. 21.1%; p = 0.02), and shorter median (interquartile range, 25-75) time from injury to operating room start (74 minutes [48-98 minutes] vs. 88 minutes [61-128 minutes]; p = 0.03) than did survivors. Multivariable Cox regression showed shorter time from emergency department arrival to operating room start was not associated with improved survival (p = 0.04).
Conclusion: Patients who died arrived to a trauma center in a similar time frame as did survivors but presented in greater physiological distress and had significantly shorter times to surgical hemorrhage intervention than did survivors. This suggests that even expediting a critically ill patient through the current trauma system is not sufficient time to save lives from NCTH. Civilian prehospital advance resuscitative care starting from the patient first contact needs special consideration.
Level Of Evidence: Prognostic/Epidemiologic, Level III.
