Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy

Ronald R. Barbosa, Susan E. Rowell, Erin E. Fox, John B. Holcomb, Eileen M. Bulger, Herb A. Phelan, Louis H. Alarcon, John G. Myers, Karen J. Brasel, Peter Muskat, Deborah J. Del Junco, Bryan A. Cotton, Charles E. Wade, Mohammad H. Rahbar, Mitchell J. Cohen, Martin A. Schreiber

Research output: Contribution to journalArticlepeer-review

28 Scopus citations

Abstract

INTRODUCTION: Focused assessment with sonography for trauma (FAST) is commonly used to facilitate the timely diagnosis of life-threatening hemorrhage in injured patients. Most patients with positive findings on FAST require laparotomy. Although it is assumed that an increasing time to operation (T-OR) leads to higher mortality, this relationship has not been quantified. This study sought to determine the impact of T-OR on survival in patients with a positive FAST who required emergent laparotomy. METHODS: We retrospectively analyzed patients from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study who underwent laparotomy within 90 minutes of presentation and had a FAST performed. Cox proportional hazards models including Injury Severity Score (ISS), age, base deficit, and hospital site were created to examine the impact of increasing T-OR on in-hospital survival at 24 hours and 30 days. The impact of time from the performance of the FAST examination to operation (TFAST-OR) on in-hospital mortality was also examined using the same model. RESULTS: One hundred fifteen patients met study criteria and had complete data. Increasing T-OR was associated with increased inhospital mortality at 24 hours (hazard ratio [HR], 1.50 for each 10-minute increase in T-OR; confidence interval [CI], 1.14-1.97; p = 0.003) and 30 days (HR, 1.41; CI, 1.18-2.10; p = 0.002). Increasing TFAST-OR was also associated with higher in-hospital mortality at 24 hours (HR, 1.34; CI, 1.03-1.72; p = 0.03) and 30 days (HR, 1.40; CI, 1.06-1.84; p = 0.02). CONCLUSION: In patients with a positive FAST who required emergent laparotomy, delay in operation was associated with increased early and late in-hospital mortality. Delays in T-OR in trauma patients with a positive FAST should be minimized.

Original languageEnglish (US)
Pages (from-to)S48-S52
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number1 SUPPL1
DOIs
StatePublished - Jul 26 2013

Keywords

  • FAST examination
  • Laparotomy
  • PROMMTT
  • Time to operation

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy'. Together they form a unique fingerprint.

Cite this