title: Defining the optimal time to the operating room may salvage early trauma deaths.
abstract: BACKGROUND
  Early trauma deaths have the potential for salvage with immediate surgery. We studied time from injury to death in this group to qualify characteristics and quantify time to the operating room, yielding the greatest opportunity for salvage.
  
  
  METHODS
  The Pennsylvania Trauma Outcomes Study (PTOS) is a comprehensive registry including all Pennsylvania trauma centers. PTOS was queried for adult trauma patients from 1999 to 2010 dying within 4 hours of injury. The distribution of time to death (TD) was examined for subgroups according to mechanism of injury, hypotension (defined as systolic blood pressure ≤ 90 mm Hg), and operation required. The 5th percentile (TD5) and the 50th percentile (TD50) were calculated from the distributions and compared using the Mann-Whitney U-test.
  
  
  RESULTS
  The PTOS yielded 6,547 deaths within 4 hours of injury. The overall TD5 and TD50 were 0:23 (hour:minute) and 0:59, respectively. Median penetrating injury times were significantly shorter than blunt injury times (TD5/TD50, 0:19/0:43 vs. 0:29/1:10). Median time was significantly shorter for hypotensive versus normotensive patients (TD5/TD50, 0:22/0:52 vs. 0:43/2:18). Operative subgroups had different TD5/TD50 (abdominal surgery [n = 607], 1:07/2:26; thoracic surgery [n = 756] 0:25/1:25; vascular surgery [n = 156], 0:35/2:15; and cranial surgery [n = 18], 1:20/2:42).
  
  
  CONCLUSIONS
  Early trauma deaths have the potential for salvage with immediate surgery. We found TD to vary based on mechanism of injury, presence of hypotension, and type of surgery needed. With the use of TD5 and TD50 benchmarks in these subgroups, a trauma system may determine if decreased time to the operating room decreases mortality. Trauma systems can use these data to further improve prehospital and initial hospital phases of care for this subset of early death trauma patients.
  
  
  METHODS
  Epidemiologic study, level III.
authors.affiliation: From the Department of Trauma and Acute Care Surgery, Walter Reed National Military Medical Center (K.N.R.), Bethesda, Maryland; Division of Trauma, Emergency Surgery, and Surgical Critical Care, Hospital of the University of Pennsylvania (C.W.S., B.P.S., P.K.K., P.M.R.), Philadelphia; and Department of Surgery, Allegheny General Hospital (A.M.), Pittsburgh, Pennsylvania.
authors.forename: Kyle N
authors.initials: KN
authors.lastname: Remick
authors.forename: C William
authors.initials: CW
authors.lastname: Schwab
authors.forename: Brian P
authors.initials: BP
authors.lastname: Smith
authors.forename: Amir
authors.initials: A
authors.lastname: Monshizadeh
authors.forename: Patrick K
authors.initials: PK
authors.lastname: Kim
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Reilly
mesh_terms: D000328:Adult; D019985:Benchmarking; D002423:Cause of Death; D004632:Emergency Medical Services / Q000458:organization & administration*; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality; D005069:Evaluation Studies as Topic; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania; D012042:Registries; D013997:Time Factors; D013996:Time and Motion Studies; D014193:Trauma Centers / Q000458:organization & administration; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery