Reinforcing the role of rural trauma laparotomy

Hemodynamic instability due to abdominal injury in rural settings may necessitate damage-control laparotomy (DCL) before transferring patients to a lead trauma hospital (LTH) for care. Studies from the United States support performing DCL at rural hospitals (RHs), but data from Canada are lacking. This study compares outcomes between patients who received DCL at RHs and those treated directly at an LTH.

A retrospective cohort study over 15 years evaluated patients transferred to our centre after receiving DCL at an RH, matched 1:1 with those who went directly to an LTH for similar injuries. The primary outcome was abdominal injury-specific complications. Data were compared using Student t, Mann-Whitney U, and Fisher exact tests.

We matched 21 patients transferred from RHs with 21 patients treated at our LTH. Injury types (blunt trauma: 81% v. 76%, p = 0.71) and Injury Severity Scores (median 34 v. 41, p = 0.37) were similar in the RH and LTH groups. Abdominal complications were common (21.4%), but no significant difference was found between the RH and LTH groups (28.6% v. 14.3%, p = 0.08). Secondary outcomes, including death (14.3% v. 28.6%, p = 0.26), open abdomen duration (1.0 d v. 0 d, p = 0.25), admission to the intensive care unit (95.2% v. 81.0%, p = 0.15), and hospital stay (16.0 d v. 17.0 d, p = 0.48) were comparable between the RH and LTH groups.

Though uncommon, DCL performed at RHs is not associated with higher morbidity or mortality rates. Collaboration between LTHs and RHs in select cases should be encouraged. Future research should focus on identifying ideal candidates, trauma system barriers, and ways to support this practice in rural settings.