A decade of experience with a selective policy for direct to operating room trauma resuscitations.

BACKGROUND

The standard paradigm for acutely injured patients involves evaluation in an emergency department (ED). Our center has employed a policy for bypassing the ED and proceeding directly to the operating room (OR) based on prehospital criteria.

METHODS

This is a retrospective analysis of all trauma patients admitted "direct to OR" (DOR) over 10 years. Demographics, injury patterns, prehospital, and in-hospital data were analyzed.

RESULTS

There were 1,407 patients admitted as DOR resuscitations. Almost half (47%) had a penetrating mechanism, and 54% had chest or abdominal injury. The mean Injury Severity Score was 19, with altered mentation (Glasgow coma score [GCS] <9) in 20% and hypotension in 16%. Most patients (68%) required surgical intervention, and 33% required emergency surgery operations (abdominal [70%] followed by thoracic [22%] and vascular [4%]). The median time to intervention was 13 minutes. Mortality was significantly lower than predicted (5% vs 10%). Independent predictors of emergent surgical intervention were a penetrating truncal injury (odds ratio = 9.9), GCS <9 (odds ratio = 1.9), and hypotension (odds ratio = 1.8).

DISCUSSION

Our DOR protocol identified a severely injured cohort at high risk for requiring surgery with improved observed survival. High-yield triage criteria for DOR admission include a penetrating truncal injury, hypotension, and a severely altered mental status.