Failure-to-rescue After Emergent Trauma Laparotomy: Does It Apply To Children?
Omar Obaid, Letitia Bible, *Marion Henry, Tanya Anand, Michael Ditillo, Lynn Gries, Adam Nelson, Molly Douglas, Lourdes Castanon, Bellal Joseph
University of Arizona, Tucson, AZ
Background:Emergent trauma laparotomy is associated with mortality rates upto 40%. There is a paucity of data on outcomes of pediatric emergent trauma laparotomies. The aim of our study was to evaluate outcomes of pediatric trauma patients who undergo emergent laparotomy.
Methods:We performed a one-year (2017) analysis of the ACS-TQIP dataset. All pediatric trauma patients (age<18years) who underwent emergent laparotomy (<2hours of admission) were included. Outcomes were in-hospital complications, overall mortality, and failure-to-rescue (death after major complication). Multivariate regression analysis was performed to identify factors independently associated with failure-to-rescue.
Findings:462 trauma patients underwent emergent laparotomy. Mean age was 14±4years, 76% of patients were male, 49% were White, and 50% had penetrating injury. Median ISS was 25[13-36], Abdomen-AIS 3[2-4], Chest-AIS 2[1-3], and Head-AIS 2[0-5]. Median time in ED was 33[18-69]minutes, and time-to-surgery was 49[33-77]minutes. The most common operative procedures performed were splenectomy(26%), hepatorrhaphy(17%), enterectomy(14%), and gastrorrhaphy(14%). Only 22% were treated at an ACS Pediatric Level I trauma center. The most common in-hospital complications were cardiac(9%), infectious(7%), and respiratory(5%). Overall mortality was 21%, and mortality among those presenting with hypotension was 31%. Among those who developed in-hospital complications, the failure-to-rescue rate was 31%. On multivariate analysis, age<8years, concomitant severe head injury, and receiving pRBCs within 24 hours were independently associated with failure-to-rescue.
Conclusions:Pediatric emergent trauma laparotomies are associated with high morbidity, mortality, and failure-to-rescue rates. Quality improvement programs may use our findings to improve patient outcomes, by increasing focus on avoiding hospital complications, and further refinement of resuscitation protocols.
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