title: High mortality after emergency room laparotomy in haemodynamically unstable trauma patients.
abstract: BACKGROUND
  Hypovolaemic shock is a major course of death in trauma patients. The mortality in patients in profound shock at the time of arrival is extremely high and we wanted to investigate the outcome of patients undergoing laparotomy at the Trauma Care Unit (TCU).
  
  
  METHODS
  Forty-four emergency laparotomies performed at the TCU at Rigshospitalet between January 2003 and December 2009 were registered. The indication for surgical intervention was based on persisting, unstable haemodynamics and either positive findings at focused abdominal sonography in trauma (FAST) or penetrating injury. In some patients, laparotomy was performed despite a negative FAST because of ongoing instability. The patients were stratified according to their systolic blood pressure (BP).
  
  
  RESULTS
  After 24 hours, 46% (20 patients) of the patients were alive. The survival after 30 days was 41% (18 patients). Stratifying the patients into three categories according to the systolic BP at the time of arrival (BP > 80 mmHg (n = 14), 80 mmHg ≥ BP > 60 mmHg (n = 10) and BP ≤ 60 mmHg (n = 20) revealed a 64%, 50% and 34% survival rate within the first 24 hours (p = 0.04). In the group of patients with BP ≤ 60 mmHg, the survival decreased to 20% after 30 days. Stratification by penetrating or blunt trauma showed no significant difference in survival (40% versus 50% survival after 30 days) (p = 0.40). However, in those patients arriving with BP ≤ 60 mmHg (five penetrating and 15 blunt injuries), we found that the survival rate after laparotomy was 60% and 13%, respectively.
  
  
  CONCLUSIONS
  The present study shows that haemodynamically unstable patients with abdominal or suspected abdominal injuries undergoing emergency laparotomy have a high mortality, especially those with BP ≤ 60 mmHg. Patients with a penetrating trauma have a far better prognosis than those with a blunt trauma.
authors.affiliation: Department of Surgery and Trauma Unit, Rigshospitalet, 2100 Copenhagen Ø, Denmark. h.lund@dadlnet.dk
authors.forename: Helle
authors.initials: H
authors.lastname: Lund
authors.forename: Steen Christian
authors.initials: SC
authors.lastname: Kofoed
authors.forename: Jens Georg
authors.initials: JG
authors.lastname: Hillingsø
authors.forename: Claus
authors.initials: C
authors.lastname: Falck-Larsen
authors.forename: Lars Bo
authors.initials: LB
authors.lastname: Svendsen
mesh_terms: D000007:Abdominal Injuries / Q000503:physiopathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007813:Laparotomy / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012769:Shock / Q000401:mortality*; D013599:Systole; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D014950:Wounds, Penetrating / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult