Predictors for Direct to Operating Room Admission in Severe Trauma.

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Critical Care

Background:

• Current protocols for expediting trauma patients to surgery vary and lack evidence.
• Physician judgment (gestalt) often dictates patient transfer pathways.
• There is a need for objective criteria to guide immediate surgical intervention for trauma patients.

Purpose of the Study:

• To identify objective factors associated with the need for immediate surgical intervention in severely injured trauma patients.
• To develop a predictive scoring system for bypassing the emergency department (ED) in critical trauma cases.
• To improve the efficiency of care for patients requiring urgent surgical management.

Main Methods:

• Retrospective analysis of high-activation trauma patients transported by air ambulance.
• Exclusion of transfer, pediatric, isolated burn, and isolated head trauma patients.
• Comparison of patients undergoing emergency general surgery within 30 minutes of arrival versus the remainder of the cohort.

Main Results:

• 10% of enrolled patients (85/863) underwent emergency surgery within 30 minutes of ED arrival.
• Patients needing rapid surgery had more penetrating injuries, lower blood pressure, and positive FAST exams.
• A "Direct to Operating Room" (DTOR) score was developed; each point increase correlated with a 2.71 odds ratio for emergency operation within 30 minutes.

Conclusions:

• Profound hypotension, acidosis, and positive FAST exams are key indicators for surgery within 30 minutes of presentation.
• A scoring system can aid prehospital identification of patients requiring immediate surgical intervention.
• Objective criteria can optimize the decision-making process for direct-to-OR trauma patient pathways.