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Outcomes by time-to-OR for penetrating abdominal trauma patients.

Publication ,  Journal Article
Grisel, B; Gordee, A; Kuchibhatla, M; Ginsberg, Z; Agarwal, S; Haines, K
Published in: Am J Emerg Med
May 2024

INTRODUCTION: Time-To-OR is a critical process measure for trauma performance. However, this measure has not consistently demonstrated improvement in outcome. STUDY DESIGN: Using TQIP, we identified facilities by 75th percentile time-to-OR to categorize slow, average, and fast hospitals. Using a GEE model, we calculated odds of mortality for all penetrating abdominal trauma patients, firearm injuries only, and patients with major complication by facility speed. We additionally estimated odds of mortality at the patient level. RESULTS: Odds of mortality for patients at slow facilities was 1.095; 95% CI: 0.746, 1.608; p = 0.64 compared to average. Fast facility OR = 0.941; 95% CI: 0.780, 1.133; p = 0.52. At the patient-level each additional minute of time-to-OR was associated with 1.5% decreased odds of in-hospital mortality (OR 0.985; 95% CI:0.981, 0.989; p < 0.001). For firearm-only patients, facility speed was not associated with odds of in-hospital mortality (p-value = 0.61). Person-level time-to-OR was associated with 1.8% decreased odds of in-hospital mortality (OR 0.982; 95% CI: 0.977, 0.987; p < 0.001) with each additional minute of time-to-OR. Similarly, failure-to-rescue analysis showed no difference in in-hospital mortality at the patient level (p = 0.62) and 0.4% decreased odds of in-hospital mortality with each additional minute of time-to-OR at the patient level (OR 0.996; 95% CI: 0.993, 0.999; p = 0.004). CONCLUSION: Despite the use of time-to-OR as a metric of trauma performance, there is little evidence for improvement in mortality or complication rate with improved time-to-OR at the facility or patient level. Performance metrics for trauma should be developed that more appropriately approximate patient outcome.

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Published In

Am J Emerg Med

DOI

EISSN

1532-8171

Publication Date

May 2024

Volume

79

Start / End Page

144 / 151

Location

United States

Related Subject Headings

  • Wounds, Penetrating
  • Wounds, Gunshot
  • Retrospective Studies
  • Injury Severity Score
  • Humans
  • Hospitals
  • Hospital Mortality
  • Firearms
  • Emergency & Critical Care Medicine
  • Abdominal Injuries
 

Citation

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ICMJE
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Grisel, B., Gordee, A., Kuchibhatla, M., Ginsberg, Z., Agarwal, S., & Haines, K. (2024). Outcomes by time-to-OR for penetrating abdominal trauma patients. Am J Emerg Med, 79, 144–151. https://doi.org/10.1016/j.ajem.2024.02.018
Grisel, Braylee, Alexander Gordee, Maragatha Kuchibhatla, Zachary Ginsberg, Suresh Agarwal, and Krista Haines. “Outcomes by time-to-OR for penetrating abdominal trauma patients.Am J Emerg Med 79 (May 2024): 144–51. https://doi.org/10.1016/j.ajem.2024.02.018.
Grisel B, Gordee A, Kuchibhatla M, Ginsberg Z, Agarwal S, Haines K. Outcomes by time-to-OR for penetrating abdominal trauma patients. Am J Emerg Med. 2024 May;79:144–51.
Grisel, Braylee, et al. “Outcomes by time-to-OR for penetrating abdominal trauma patients.Am J Emerg Med, vol. 79, May 2024, pp. 144–51. Pubmed, doi:10.1016/j.ajem.2024.02.018.
Grisel B, Gordee A, Kuchibhatla M, Ginsberg Z, Agarwal S, Haines K. Outcomes by time-to-OR for penetrating abdominal trauma patients. Am J Emerg Med. 2024 May;79:144–151.
Journal cover image

Published In

Am J Emerg Med

DOI

EISSN

1532-8171

Publication Date

May 2024

Volume

79

Start / End Page

144 / 151

Location

United States

Related Subject Headings

  • Wounds, Penetrating
  • Wounds, Gunshot
  • Retrospective Studies
  • Injury Severity Score
  • Humans
  • Hospitals
  • Hospital Mortality
  • Firearms
  • Emergency & Critical Care Medicine
  • Abdominal Injuries