title: Trauma laparotomy in a rural setting before transfer to a regional center: does it save lives?
abstract: 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.
authors.affiliation: Mayo Clinic-Scottsdale, Arizona, USA.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Weinberg
authors.forename: Kim
authors.initials: K
authors.lastname: McKinley
authors.forename: Scott R
authors.initials: SR
authors.lastname: Petersen
authors.forename: Gerald B
authors.initials: GB
authors.lastname: Demarest
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Timberlake
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Gardner
mesh_terms: 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