title: Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes.
abstract: OBJECTIVE
  We examined the relationship between survival and time in the emergency department (ED) before laparotomy for hypotensive patients bleeding from abdominal injuries.
  
  
  METHODS
  Patients in the Pennsylvania Trauma Systems Foundation trauma registry with isolated abdominal vascular, solid organ, or wall injuries grade 3 to 6 and hypotension were identified. Deaths were predicted from the prehospital time, systolic blood pressure (SBP) on ED admission, and time in the ED before either laparotomy or ED death.
  
  
  RESULTS
  Two-hundred forty-three patients met the criteria. SBP ranged from 30 to 90 mm Hg. Time to the ED ranged from 7 to 185 minutes. Time in the ED ranged from 7 to 915 minutes. Overall, 98 patients died (40%). The risk ratio for the SBP increased, as expected, as SBP dropped. The risk ratio for time spent in the ED before laparotomy increased until 90 minutes, then significantly decreased below all earlier values. Logistic regression on the 165 patients spending 90 minutes or less in the ED showed that the probability of death increased with time in the ED. The increase was as much as 0.35% per minute.
  
  
  CONCLUSIONS
  Among patients in a trauma registry who were hypotensive on arrival in the ED and had major injuries isolated to the abdomen requiring emergency laparotomy, the probability of death showed a relationship to both the extent of hypotension and the length of time in the ED for patients who were in the ED for 90 minutes or less. The probability of death increased approximately 1% for each 3 minutes in the ED.
authors.affiliation: Department of Surgery, MCP-Hahnemann, Philadelphia, Pennsylvania 19129, USA. jclarke@gradient.cis.upenn.edu
authors.forename: John R
authors.initials: JR
authors.lastname: Clarke
authors.forename: Stanley Z
authors.initials: SZ
authors.lastname: Trooskin
authors.forename: Prashant J
authors.initials: PJ
authors.lastname: Doshi
authors.forename: Lloyd
authors.initials: L
authors.lastname: Greenwald
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Mode
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000401:mortality* / Q000601:surgery; D004636:Emergency Service, Hospital; D006470:Hemorrhage / Q000150:complications / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000209:etiology; D015601:Injury Severity Score; D016015:Logistic Models; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors