Predictors for Direct to Operating Room Admission in Severe Trauma.

Abstract

BACKGROUND\nProtocols for expediting critical trauma patients directly from the helipad to the operating room tend to vary by center, rely heavily on physician gestalt, and lack supporting evidence. We evaluated a population of severely injured trauma patients with the aim of determining objective factors associated with the need for immediate surgical intervention.\n\n\nMETHODS\nAll highest-activation trauma patients transported by air ambulance between 1/1/16 and 12/31/17 were enrolled retrospectively. Transfer, pediatric, isolated burn, and isolated head trauma patients were excluded. Patients who underwent emergency general surgery within 30\xa0min of arrival without the aid of cross-sectional imaging were compared to the remainder of the cohort.\n\n\nRESULTS\nOf the 863 patients who were enrolled, 85 (10%) spent less than 30\xa0min in the emergency department (ED) before undergoing an emergency operation. The remaining 778 patients (90%) formed the comparison group. The ED\xa0≤\xa030\xa0min group had a higher percentage of penetrating injuries, lower blood pressure, and was more likely to have a positive FAST exam. The Direct to Operating Room (DTOR) score is a predictive scoring system devised to identify patients most likely to benefit from bypassing the ED. The odds ratio of emergency operation within 30\xa0min of hospital arrival increased by 2.71 (95% confidence interval 2.23-3.29; P\xa0<\xa00.001) for every 1-point increase in DTOR score.\n\n\nCONCLUSIONS\nTrauma patients with profound hypotension or acidosis and positive FAST were more likely to require surgery within 30\xa0min of hospital presentation. Use of a scoring system may allow early identification of these patients in the prehospital setting by nonphysician providers.