title: Impact of urgent resuscitative surgery for life-threatening torso trauma.
abstract: OBJECTIVE
  This study investigated the advantages of performing urgent resuscitative surgery (URS) in the emergency department (ED); namely, our URS policy, to avoid a delay in hemorrhage control for patients with severe torso trauma and unstable vital signs.
  
  
  METHODS
  We divided 264 eligible cases into a URS group (n = 97) and a non-URS group (n = 167) to compare, retrospectively, the observed survival rate with the predicted survival using the Trauma and Injury Severity Score (TRISS).
  
  
  RESULTS
  While the revised trauma score and the injury severity score were significantly lower in the URS group than in the non-URS group, the observed survival rate was significantly higher than the predicted rate in the URS (48.5 vs. 40.2%; p = 0.038). URS group patients with a systolic blood pressure (SBP) <90 mmHg and a Glasgow coma scale (GCS) score of ≥9 had significantly higher observed survival rates than predicted survival rates (0.433 vs. 0.309, p = 0.008), (0.795 vs. 0.681, p = 0.004). The implementation of damage control surgery (DCS) was found to be a significant predictor of survival (OR 5.23, 95% CI 0.113-0.526, p < 0.010).
  
  
  CONCLUSIONS
  The best indications for the URS policy are an SBP <90 mmHg, a GCS ≥9 on ED arrival, and/or the need for DCS. By implementing our URS policy, satisfactory survival of patients requiring immediate hemostatic surgery was achieved.
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan. hmatsu@nms.ac.jp.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan. hmatsu@nms.ac.jp.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Matsumoto
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Hara
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Yagi
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Saito
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Kazuki
authors.initials: K
authors.lastname: Mashiko
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Iida
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Motomura
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Nakayama
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Okada
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yasumatsu
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Taigo
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Seo
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Konda
authors.affiliation: Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, 1715, Kamakari, Inzai, Chiba Prefecture, 270-1694, Japan.|Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: You
authors.initials: Y
authors.lastname: Hattori
authors.affiliation: Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokota
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D005260:Female; D015600:Glasgow Coma Scale; D006470:Hemorrhage / Q000401:mortality / Q000517:prevention & control* / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D013599:Systole; D060726:Torso / Q000293:injuries* / Q000601:surgery*; D015599:Trauma Severity Indices; D055986:Vital Signs
keywords: Damage control surgery; Emergency department; Hemostatic operation; Resuscitative thoracotomy; Trauma resuscitation