Jeong Soon Tak, Park Yun Chul, Jo Young Goun, Kang Wu Seong
Department of Physical Medicine and Rehabilitation, Ansanhyo Hospital, Ansan City, Republic of Korea.
Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea.
Sci Rep. 2025 Jan 22;15(1):2808. doi: 10.1038/s41598-025-87241-y.
Traumatic intra-abdominal hemorrhage contributes to mortality in patients with trauma. However, initiating an emergent laparotomy in the operating room (OR) as a standard treatment can sometimes be time-consuming. To overcome this issue, laparotomy is performed in the emergency room (ER) in some institutions. This systematic review evaluates the efficacy of performing ER laparotomy. Comprehensive searches were conducted in MEDLINE PubMed, EMBASE, and Cochrane databases, up to August 9, 2024. The risk of bias in observational studies was assessed using the ROBINS-I tool. The primary outcome was mortality following ER laparotomy, and the secondary outcome was time from admission to first laparotomy. The review included 10 studies, all of which were observational. A meta-analysis was not performed due to substantial heterogeneity and insufficient data. Mortality rates after ER laparotomy ranged from 23 to 100%. Mortality rates were 23.0-66.7% in the conventional ER group, while they were 0-30% in the OR group. In the hybrid ER group, the 28-day mortality rates were 12.7-15%, compared to 21.7-22% in the conventional group. The time from admission to the first laparotomy was 17-43 min (median) in the conventional ER group, compared to 40-111 min (median) in the OR laparotomy group. In the hybrid ER setting, the time from admission to intervention, including laparotomy, was 35-48 min (median), whereas it was 72-101 min (median) in the conventional group. A high and unclear risk of bias due to confounding was noted across the studies. ER laparotomy may provide rapid bleeding control. However, due to the limited number of studies and significant heterogeneity among the studies reviewed, the true effect size of ER laparotomy in conventional and hybrid ER settings remains unclear.
创伤性腹腔内出血会导致创伤患者死亡。然而，在手术室（OR）进行紧急剖腹手术作为标准治疗有时可能耗时较长。为克服这一问题，一些机构在急诊室（ER）进行剖腹手术。本系统评价评估了在急诊室进行剖腹手术的疗效。截至2024年8月9日，在MEDLINE PubMed、EMBASE和Cochrane数据库中进行了全面检索。使用ROBINS - I工具评估观察性研究中的偏倚风险。主要结局是急诊室剖腹手术后的死亡率，次要结局是从入院到首次剖腹手术的时间。该评价纳入了10项研究，均为观察性研究。由于存在显著异质性且数据不足，未进行荟萃分析。急诊室剖腹手术后的死亡率在23%至100%之间。传统急诊室组的死亡率为23.0% - 66.7%，而手术室组为0% - 30%。在混合急诊室组中，28天死亡率为12.7% - 15%，而传统组为21.7% - 22%。传统急诊室组从入院到首次剖腹手术的时间为17 - 43分钟（中位数），而手术室剖腹手术组为40 - 111分钟（中位数）。在混合急诊室环境中，从入院到包括剖腹手术在内的干预时间为35 - 48分钟（中位数），而传统组为72 - 101分钟（中位数）。各项研究均指出因混杂因素导致的偏倚风险较高且不明确。急诊室剖腹手术可能有助于快速控制出血。然而，由于研究数量有限且所纳入研究之间存在显著异质性，急诊室剖腹手术在传统和混合急诊室环境中的真实效应大小仍不明确。
