Department of Surgery, The University of Kansas School of Medicine - Wichita, Wichita, KS, USA.
Department of Surgery, The University of Kansas School of Medicine - Wichita, Wichita, KS, USA; Department of Medical Education, Via Christi Hospital Saint Francis, Wichita, KS, USA.
Am J Surg. 2019 Sep;218(3):490-495. doi: 10.1016/j.amjsurg.2019.01.005. Epub 2019 Jan 10.
The majority of motor vehicle crashes occur in a rural setting and those patients have double the mortality of their urban counterparts. These trauma patients are at times stabilized at rural hospitals before transfer to a Level 1 trauma center. The purpose of this study was to determine the outcomes of rural damage control laparotomy used as a means of pre-transfer stabilization.
A nearly 7-year retrospective review was conducted of rural trauma patients who had laparotomies before or after transfer to Level 1 center. They were grouped into three categories: damage control laparotomy at rural hospital, patients unstable during transfer or stable during transfer with subsequent laparotomy.
Forty-seven patients met study criteria. Overall mortality was significantly different between patients who had damage control laparotomy at a rural hospital (14.3%), were unstable transfer patients (75.0%), and stable transfer patients (3.3%; P < 0.001).
Rural damage control laparotomy may be used as a means of stabilization prior to transfer to a Level 1 center, and in appropriate patients may be life-saving.
大多数机动车事故发生在农村地区，这些患者的死亡率是城市患者的两倍。这些创伤患者有时在转移到一级创伤中心之前会在农村医院进行稳定治疗。本研究的目的是确定作为转移前稳定手段的农村损伤控制性剖腹术的结果。
对在转移到一级中心之前或之后进行剖腹术的农村创伤患者进行了近 7 年的回顾性研究。他们分为三组：农村医院进行的损伤控制性剖腹术、在转移过程中不稳定的患者或在转移过程中稳定但随后进行剖腹术的患者。
47 名患者符合研究标准。在农村医院进行损伤控制性剖腹术的患者（14.3%）、在转移过程中不稳定的患者（75.0%）和在转移过程中稳定但随后进行剖腹术的患者（3.3%）之间，死亡率有显著差异（P < 0.001）。
农村损伤控制性剖腹术可作为转移到一级中心前的稳定手段，在适当的患者中可能具有救生作用。
