Abstract：
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). DISCUSSION: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.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
Martin M,Izenberg S,Cole F,Bergstrom S,Long Wdoi
10.1016/j.amjsurg.2012.06.001subject
Has Abstractpub_date
2012-08-01 00:00:00pages
187-92issue
2eissn
0002-9610issn
1879-1883pii
S0002-9610(12)00294-2journal_volume
204pub_type
杂志文章abstract：BACKGROUND:In recent years, increasingly accessible and novel genetic technologies have spurred keen interest in the application of cancer genetics in predicting prognosis and response to treatment. In particular, investigators have eagerly sought to establish and validate genetic signatures that might improve the iden...
journal_title：American journal of surgery
pub_type： 杂志文章,评审
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abstract：:Common duct stones retained after choledocholithotomy were removed in 11 patients under intravenous sedation using the Olympus fiberoptic choledochoscope passed through a T-tube tract. A total of 39 stones were removed during 12 procedures, with one patient requiring 2 procedures for complete stone removal. All common...
journal_title：American journal of surgery
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journal_title：American journal of surgery
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journal_title：American journal of surgery
pub_type： 杂志文章,评审
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journal_title：American journal of surgery
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journal_title：American journal of surgery
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journal_title：American journal of surgery
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journal_title：American journal of surgery
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更新日期：2003-05-01 00:00:00
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