Trauma laparotomy in a rural setting before transfer to a regional center: does it save lives?
BACKGROUND
In the rural setting, long distances may necessitate that a patient undergo emergency laparotomy before transfer to a regional trauma center for definitive management. The purpose of this study was to review the experience of three regional trauma centers with such treated patients.


METHODS
This study was a retrospective chart review of patients who underwent emergency laparotomy for trauma before transfer, identified from the respective databases of participating centers over a 6-year period.


RESULTS
Fifty-six patients met the study criteria. Twenty-six (46%) were transferred primarily for management of the abdominal injury, and 14 of these patients (25% overall) underwent damage control procedures. Overall survival was 82%. Logistic regression demonstrated that transfer for treatment of the extra-abdominal injury was the only significant predictor of survival (odds ratio, 34.33; 95% confidence interval, 1.80-655.24).


CONCLUSIONS
Although patients undergoing laparotomy who were subsequently transferred for management of abdominal injury have reasonable outcome, patients transferred primarily for management of extra-abdominal injury seem to have a survival advantage.
Weinberg
Jordan A
JA
Mayo Clinic-Scottsdale, Arizona, USA.
McKinley
Kim
K
Petersen
Scott R
SR
Demarest
Gerald B
GB
Timberlake
Gregory A
GA
Gardner
Ronald S
RS
D000007:Abdominal Injuries / Q000145:classification / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007813:Laparotomy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012041:Regional Medical Programs; D012189:Retrospective Studies; D019035:Rural Health Services; D016019:Survival Analysis; D015599:Trauma Severity Indices