Department of Surgery, Shamir Medical Center, Zeriffin, affiliated with Sackler Faculty of Medicine. Tel Aviv University, Tel Aviv, Zerifin 70300, Israel.
National Center for Trauma and Emergency Medicine Research, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel; The Department of Emergency Management &Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Injury. 2021 Feb;52(2):195-199. doi: 10.1016/j.injury.2020.09.043. Epub 2020 Sep 29.
Treatment recommendations for patients with penetrating abdominal injury are well established. Trauma victims with clear indications for surgery, should undergo immediate operative intervention without any delay or additional imaging. However, the optimal time for surgery remains unclear. There are some significant advantages in preoperative abdominal CT, including gathering essential information regarding a few difficult to reach anatomical areas, avoiding unnecessary explorations associated with increased morbidity and assessing the existence of extra-abdominal injuries that may have non-expectable impact on initial therapeutic plan. The aim of this study was to determine the impact of "time-to-surgery" on final medical outcomes in patients with penetrating abdominal trauma with normal blood pressure on admission.
A retrospective cohort study using the Israeli National Trauma Registry was conducted from 2000- 2018. This study included trauma patients with penetrating injuries and a systolic blood pressure of 90mmHg or above on admission. All patients included in the study were divided into three groups according to the time that lapsed from their admission to surgery: half an hour, an hour, and two hours. We assessed the outcome for each patient, including length of hospital stay, need for intensive care and mortality. Statistical analysis was performed using the Chi-square test, ANOVA test. A p-value of less than 0.05 was considered statistically significant.
The study included 1,136 penetrating trauma patients. Among these, 78.0% (886) had sustained low-energy penetrating injury (SWPI) and 22.0% (250) had sustained high-energy penetrating injury (FAPI). Males accounted for 93.5% (1,062) of the patients. Mean age was 30.4. About 29% (327) of all the patients underwent surgery within 30 minutes from admission, 42% (475) within 30-60 min, and 29% (334) patients were operated within one to two hours. Patients who underwent surgery within 30 minutes, had worse ISS and GCS scores and were, therefore, more likely to have worse clinical outcomes. No other differences in outcomes were found in patients who were operated upon within 2 hours.
Time to surgery within two hours from admission has no impact on final outcomes in trauma patients with penetrating injury and normal blood pressure on admission.
对于穿透性腹部损伤患者的治疗建议已经得到很好的确立。对于有明确手术指征的创伤患者，应立即进行手术干预，而无需任何延迟或额外的影像学检查。然而，手术的最佳时机仍不清楚。术前腹部 CT 有一些显著的优势，包括获取一些难以触及的解剖区域的重要信息，避免因增加发病率而进行不必要的探查，并评估可能对初始治疗计划产生意外影响的腹腔外损伤的存在。本研究的目的是确定在入院时血压正常的穿透性腹部创伤患者中，“手术时间”对最终医疗结果的影响。
使用以色列国家创伤登记处进行了一项回顾性队列研究，时间为 2000 年至 2018 年。本研究包括穿透性损伤且入院时收缩压为 90mmHg 或以上的创伤患者。所有纳入研究的患者根据从入院到手术的时间分为三组：半小时、一小时和两小时。我们评估了每位患者的结果，包括住院时间、需要重症监护和死亡率。使用卡方检验、方差分析进行统计学分析。p 值小于 0.05 被认为具有统计学意义。
该研究纳入了 1136 例穿透性创伤患者。其中，78.0%（886 例）为低能穿透伤（SWPI），22.0%（250 例）为高能穿透伤（FAPI）。男性占患者的 93.5%（1062 例）。平均年龄为 30.4 岁。约 29%（327 例）的患者在入院后 30 分钟内进行了手术，42%（475 例）在 30-60 分钟内进行了手术，29%（334 例）患者在 1-2 小时内进行了手术。在 30 分钟内进行手术的患者 ISS 和 GCS 评分较差，因此更有可能出现较差的临床结果。在 2 小时内进行手术的患者中没有发现其他结果差异。
在入院后 2 小时内进行手术对入院时血压正常的穿透性创伤患者的最终结局没有影响。
