Trauma Laparotomy in a Rural Setting before Transfer to a Regional Center: Does It Save Lives?

Weinberg, Jordan A.; McKinley, K.P.; Petersen, Scott R.; Demarest, Gerald B.; Timberlake, Gregory A.; Gardner, Ronald S.

doi:10.1097/01.ta.0000063001.61469.3e

Cited by 11 publications

(8 citation statements)

References 15 publications

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“…Hospital characteristics may include volume of spleen injuries, location, ownership/control, teaching status, hospital type (general vs pediatric), and level of trauma designation. [14][15][16][17] This study was designed to investigate hospital factors that relate to pediatric spleen conservation using a large national database of child hospitalizations and procedures. We tested the hypothesis that children were more likely to undergo splenectomy in general hospitals than in children's hospitals.…”

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confidence: 99%

Hospital Characteristics Associated With the Management of Pediatric Splenic Injuries

Bowman

Zimmerman

Christakis

et al. 2005

JAMA

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Context Despite evidence that more than 90% of children with traumatic injuries to the spleen can be successfully managed nonoperatively, there is significant variation in the use of splenectomy. As asplenic children are at increased risk of overwhelming postsplenectomy infection, nonoperative management may be considered a quality of care indicator.Objective To test the hypothesis that children are more likely to undergo splenectomy in general hospitals than in children's hospitals.Design Retrospective cohort study using data from the Kid's Inpatient Database (KID) for the year 2000. Multivariable regression was used to control for patient and hospital characteristics.Setting and Participants All children aged 0 to 16 years who were hospitalized with a traumatic (noniatrogenic) spleen injury in nonfederal short-stay hospitals in any of the 27 states participating in KID (N=2851). Main Outcome Measure Splenectomy performed within 1 day of arrival.Results A total of 11 children (3%) with splenic injuries receiving care at children's hospitals underwent splenectomy compared with 383 children (15.4%) cared for at general hospitals (PϽ.001). After adjusting for patient characteristics, injury severity, and hospital characteristics, splenectomy was more likely among children treated at general hospitals (odds ratio, 5.01; 95% confidence interval, 2.21-11.36) than among children treated at children's hospitals. ConclusionsThere is considerable variation in the management of pediatric splenic injuries, with significantly lower rates of splenectomy at designated children's hospitals. Quality improvement interventions, including increased education and training for physicians in general hospitals, may be needed to increase the use of spleenconserving management practices.

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confidence: 99%

Hospital Characteristics Associated With the Management of Pediatric Splenic Injuries

Bowman

Zimmerman

Christakis

et al. 2005

JAMA

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“…Nevertheless, these results are certainly in line with previous literature on surgical stabilization prior to transfer. 14,20 There was a decrease in the proportion of UTIs in all patients though only significant in patients transferred after laparotomy. This is likely due to increased vigilance in recent years to reduce catheter associated UTIs.…”

Section: Discussionmentioning

confidence: 93%

“…Weinberg et al 20 analyzed 56 patients over a 6-year period who had emergency laparotomy at referring facilities prior to transfer to the three Level I trauma centers serving large rural catchment areas. They showed that, in logistic regression analysis, only transfer for management of an extra-abdominal injury rather than for abdominal injury management showed a survival benefit 20 . Harwell et al 14 evaluated patients who had laparotomy before and after transfer to a Level I center.…”

Section: Discussionmentioning

confidence: 99%

Surgical stabilization of critical abdominal injuries in a mature rural trauma system: A retrospective study

Tinsman

Lilienthal

Galet

et al. 2022

J Trauma Acute Care Surg

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“…These patients may be particularly suited to damage control techniques-control of bleeding, stabilization, and transfer for definitive care. Weinberg and associates 22 have demonstrated the applicability of damage control surgery in the rural environment in salvaging critically injured patients. From Missouri Level III registry information, it is difficult to determine which operations were performed for damage control.…”

Section: Discussionmentioning

confidence: 98%

Trauma Care at Rural Level III Trauma Centers in a State Trauma System

Helling¹

2007

Journal of Trauma: Injury, Infection &Amp; Critical Care

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Trauma Laparotomy in a Rural Setting before Transfer to a Regional Center: Does It Save Lives?

Abstract: Although patients undergoing laparotomy who were subsequently transferred for management of abdominal injury have reasonable outcome, patients transferred primarily for management of extra-abdominal injury seem to have a survival advantage.

Cited by 11 publications

References 15 publications

Hospital Characteristics Associated With the Management of Pediatric Splenic Injuries

Hospital Characteristics Associated With the Management of Pediatric Splenic Injuries

Surgical stabilization of critical abdominal injuries in a mature rural trauma system: A retrospective study

Trauma Care at Rural Level III Trauma Centers in a State Trauma System

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