Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2013 Jul;75(1 Suppl 1):S48-52.
doi: 10.1097/TA.0b013e31828fa54e.

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

Ronald R Barbosa  1 , Susan E Rowell, Erin E Fox, John B Holcomb, Eileen M Bulger, Herbert 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; PROMMTT Study Group
Collaborators, Affiliations
Multicenter Study

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

Ronald R Barbosa et al. J Trauma Acute Care Surg. 2013 Jul.

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 in-hospital 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Survival curve for FAST(+) patients undergoing laparotomy in ≤ 90 minutes * Mean T-OR for the cohort was 36 minutes ** Theoretical curve for patients with T-OR = 56 minutes
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Committee on Injury Prevention and Control; Institute of MedicineBonne RJ, Fulco CE, Liverman CT, editors. Reducing the Burden of Injury: Advancing Prevention and Treatment. National Academy Press; Washington, DC: 1999. pp. 42–43. - PubMed
    1. American College of Surgeons Committee on Trauma . Resources for Optimal Care of the Injured Patient. American College of Surgeons; Chicago: 2006.
    1. Hemmila MR, Nathens AB, Shafi S, et al. The Trauma Quality Improvement Program: pilot study and initial demonstration of feasibility. J Trauma. 2010;68(2):253–262. - PubMed
    1. Stelfox HT, Bobranska-Artiuch B, Nathens A, et al. Quality indicators for evaluating trauma care. A scoping review. Arch Surg. 2010;145:286–295. - PubMed
    1. Wright KD, Knowles CGH, Coats TJ, et al. Efficient timely evacuation of intracranial haematoma – the effect of transport direct to a specialist centre. Injury. 1996;27:719–721. - PubMed

Publication types

MeSH terms