title: Increasing time to operation is associated with decreased survival in patients with a positive FAST examination requiring emergent laparotomy.
abstract: BACKGROUND
  Focused assessment with sonography for trauma (FAST) is commonly used to facilitate the timely diagnosis of life-threatening hemorrhage in injured patients. Most patients with positive findings on FAST require laparotomy. Although it is assumed that an increasing time to operation (T-OR) leads to higher mortality, this relationship has not been quantified. This study sought to determine the impact of T-OR on survival in patients with a positive FAST who required emergent laparotomy.
  
  
  METHODS
  We retrospectively analyzed patients from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study who underwent laparotomy within 90 minutes of presentation and had a FAST performed. Cox proportional hazards models including Injury Severity Score (ISS), age, base deficit, and hospital site were created to examine the impact of increasing T-OR on in-hospital survival at 24 hours and 30 days. The impact of time from the performance of the FAST examination to operation (TFAST-OR) on in-hospital mortality was also examined using the same model.
  
  
  RESULTS
  One hundred fifteen patients met study criteria and had complete data. Increasing T-OR was associated with increased in-hospital mortality at 24 hours (hazard ratio [HR], 1.50 for each 10-minute increase in T-OR; confidence interval [CI], 1.14-1.97; p = 0.003) and 30 days (HR, 1.41; CI, 1.18-2.10; p = 0.002). Increasing TFAST-OR was also associated with higher in-hospital mortality at 24 hours (HR, 1.34; CI, 1.03-1.72; p = 0.03) and 30 days (HR, 1.40; CI, 1.06-1.84; p = 0.02).
  
  
  CONCLUSIONS
  In patients with a positive FAST who required emergent laparotomy, delay in operation was associated with increased early and late in-hospital mortality. Delays in T-OR in trauma patients with a positive FAST should be minimized.
authors.affiliation: From the Trauma Services, Legacy Emanuel Hospital and Health Center, Portland, Oregon 97227, USA. rbarbosa@lhs.org
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Barbosa
authors.forename: Susan E
authors.initials: SE
authors.lastname: Rowell
authors.forename: Erin E
authors.initials: EE
authors.lastname: Fox
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
authors.forename: Herbert A
authors.initials: HA
authors.lastname: Phelan
authors.forename: Louis H
authors.initials: LH
authors.lastname: Alarcon
authors.forename: John G
authors.initials: JG
authors.lastname: Myers
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Brasel
authors.forename: Peter
authors.initials: P
authors.lastname: Muskat
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: del Junco
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Cotton
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Rahbar
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Cohen
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014463:Ultrasonography; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*