A decade of experience with a selective policy for direct to operating room trauma resuscitations.
BACKGROUND
The standard paradigm for acutely injured patients involves evaluation in an emergency department (ED). Our center has employed a policy for bypassing the ED and proceeding directly to the operating room (OR) based on prehospital criteria.


METHODS
This is a retrospective analysis of all trauma patients admitted "direct to OR" (DOR) over 10 years. Demographics, injury patterns, prehospital, and in-hospital data were analyzed.


RESULTS
There were 1,407 patients admitted as DOR resuscitations. Almost half (47%) had a penetrating mechanism, and 54% had chest or abdominal injury. The mean Injury Severity Score was 19, with altered mentation (Glasgow coma score [GCS] <9) in 20% and hypotension in 16%. Most patients (68%) required surgical intervention, and 33% required emergency surgery operations (abdominal [70%] followed by thoracic [22%] and vascular [4%]). The median time to intervention was 13 minutes. Mortality was significantly lower than predicted (5% vs 10%). Independent predictors of emergent surgical intervention were a penetrating truncal injury (odds ratio = 9.9), GCS <9 (odds ratio = 1.9), and hypotension (odds ratio = 1.8).


CONCLUSIONS
Our DOR protocol identified a severely injured cohort at high risk for requiring surgery with improved observed survival. High-yield triage criteria for DOR admission include a penetrating truncal injury, hypotension, and a severely altered mental status.
Division of Trauma, Legacy Emanuel Medical Center, Portland, OR, USA. matthew.martin1@us.army.mil
Matthew
M
Martin
Seth
S
Izenberg
Frederick
F
Cole
Sue
S
Bergstrom
William
W
Long
D000328:Adult; D015505:Chest Tubes; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007022:Hypotension / Q000453:epidemiology; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D009873:Operating Rooms; D009922:Oregon / Q000453:epidemiology; D016134:Organizational Policy; D010343:Patient Admission; D012151:Resuscitation; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D013997:Time Factors; D014193:Trauma Centers; D014194:Traumatology; D014218:Triage / Q000379:methods*; D014947:Wounds and Injuries / Q000401:mortality / Q000601:surgery*