Duration and predictors of emergency surgical operations - basis for medical management of mass casualty incidents

European Journal of Medical Research

K-G Kanz¹  W Mutschler¹  P Biberthaler¹  AO Paul¹  PN Khalil¹  J Stegmaier¹  MV Kay¹  R Lefering²  S Huber-Wagner¹ 

[1] Munich University Hospital, Department of Trauma Surgery - Campus Innenstadt, Ludwig-Maximilians-University Munich, Germany;IFOM - Institute for Research in Operative Medicine, University Witten/Herdecke, Faculty of Medicine, Cologne, Germany

关键词: Disaster medicine;    Emergency planning;    Lifesaving procedure;    Emergency operation;    Triage;    MCI;    Mass casualty incident;    Multiple casualty incidents;   

Others  :  1093417
DOI  :  10.1186/2047-783X-14-12-532

 received in 2009-06-23, accepted in 2009-08-14,  发布年份 2009

【 摘 要 】

Background

Hospitals have a critically important role in the management of mass causality incidents (MCI), yet there is little information to assist emergency planners. A significantly limiting factor of a hospital's capability to treat those affected is its surgical capacity. We therefore intended to provide data about the duration and predictors of life saving operations.

Methods

The data of 20,815 predominantly blunt trauma patients recorded in the Trauma Registry of the German-Trauma-Society was retrospectively analyzed to calculate the duration of life-saving operations as well as their predictors. Inclusion criteria were an ISS ≥ 16 and the performance of relevant ICPM-coded procedures within 6 h of admission.

Results

From 1,228 patients fulfilling the inclusion criteria 1,793 operations could be identified as life-saving operations. Acute injuries to the abdomen accounted for 54.1% followed by head injuries (26.3%), pelvic injuries (11.5%), thoracic injuries (5.0%) and major amputations (3.1%). The mean cut to suture time was 130 min (IQR 65-165 min). Logistic regression revealed 8 variables associated with an emergency operation: AIS of abdomen ≥ 3 (OR 4,00), ISS ≥ 35 (OR 2,94), hemoglobin level ≤ 8 mg/dL (OR 1,40), pulse rate on hospital admission < 40 or > 120/min (OR 1,39), blood pressure on hospital admission < 90 mmHg (OR 1,35), prehospital infusion volume ≥ 2000 ml (OR 1,34), GCS ≤ 8 (OR 1,32) and anisocoria (OR 1,28) on-scene.

Conclusions

The mean operation time of 130 min calculated for emergency life-saving surgical operations provides a realistic guideline for the prospective treatment capacity which can be estimated and projected into an actual incident admission capacity. Knowledge of predictive factors for life-saving emergency operations helps to identify those patients that need most urgent operative treatment in case of blunt MCI.

【 授权许可】

   
2009 I. Holzapfel Publishers

【 参考文献 】

• [1]Hirshberg A, Stein M, Walden R: Surgical resource utilization in urban terrorist bombing: a computer simulation. J Trauma 1999, 47(3):545-50.
• [2]Frykberg ER, Tepas JJ: Terrorist bombings. Lessons learned from Belfast to Beirut. Ann Surg 1988, 208(5):569-76.
• [3]Mallonee S, Shariat S, Stennies G, Waxweiler R, Hogan D, Jordan F: Physical injuries and fatalities resulting from the Oklahoma City bombing. Jama 1996, 276(5):382-7.
• [4]Hirshberg A, Scott BG, Granchi T, Wall MJ Jr, Mattox KL, Stein M: How does casualty load affect trauma care in urban bombing incidents? A quantitative analysis. J Trauma 2005, 58(4):686-93; discussion 694-5.
• [5]Stein M, Hirshberg A, Gerich T: Mass casualties after an explosion. Unfallchirurg 2003, 106(10):802-10.
• [6]Hirshberg A, Holcomb JB, Mattox KL: Hospital trauma care in multiple-casualty incidents: a critical view. Ann Emerg Med 2001, 37(6):647-52.
• [7]Trauma register of the German Society of Trauma Surgery: "Scoring" study committee of the German Society of Trauma Surgery. Unfallchirurg 1994, 97(4):230-7.
• [8]Ruchholtz S: The Trauma Registry of the German Society of Trauma Surgery as a basis for interclinical quality management. A multicenter study of the German Society of Trauma Surgery. Unfallchirurg 2000, 103(1):30-7.
• [9]Ruchholtz S: External quality management in the clinical treatment of severely injured patients. Unfallchirurg 2004, 107(10):835-43.
• [10]Ruchholtz S, Nast-Kolb D, Waydhas C, Lefering R: The trauma register of the 'Polytrauma' Committee of the German Society of Trauma Surgery as the basis for quality management in the management of severely injured patients. Langenbecks Arch Chir Suppl Kongressbd 1997, 114:1265-7.
• [11]Garner A, Lee A, Harrison K, Schultz CH: Comparative analysis of multiple-casualty incident triage algorithms. Ann Emerg Med 2001, 38(5):541-8.
• [12]Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG: The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996, 22(7):707-10.
• [13]Gutierrez de Ceballos JP, Turegano Fuentes F, Perez Diaz D, Sanz Sanchez M, Martin Llorente C, Guerrero Sanz JE: Casualties treated at the closest hospital in the Madrid, March 11, terrorist bombings. Crit Care Med 2005, 33(1 Suppl):S107-12.
• [14]Lockey DJ, Mackenzie R, Redhead J, Wise D, Harris T, Weaver A, Hines K, Davies GE: London bombings July 2005: the immediate pre-hospital medical response. Resuscitation 2005, 66(2):ix-xii.
• [15]Stein M, Hirshberg A: Medical consequences of terrorism. The conventional weapon threat. Surg Clin North Am 1999, 79(6):1537-52.
• [16]Kluger Y, Peleg K, Daniel-Aharonson L, Mayo A: The special injury pattern in terrorist bombings. J Am Coll Surg 2004, 199(6):875-9.
• [17]Almogy G, Rivkind AI: Surgical lessons learned from suicide bombingattacks. J Am Coll Surg 2006, 202(2):313-9.
• [18]Peleg K, Aharonson-Daniel L, Stein M, Michaelson M, Kluger Y, Simon D, Noji EK: Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel. Ann Surg 2004, 239(3):311-8.
• [19]Peleg K, Aharonson-Daniel L, Michael M, Shapira SC: Patterns of injury in hospitalized terrorist victims. Am J Emerg Med 2003, 21(4):258-62.
• [20]Benson M, Koenig KL, Schultz CH: Disaster triage: START, then SAVE--a new method of dynamic triage for victims of a catastrophic earthquake. Prehospital Disaster Med 1996, 11(2):117-24.
• [21]Super G, Groth S, Hook R: START: Simple triage and rapid treatment plan. Hoag Memorial Hospital Presbyterian 1994.
• [22]Morales CH, Villegas MI, Villavicencio R, Gonzalez G, Perez LF, Pena AM, Vanegas LE: Intra-abdominal infection in patients with abdominal trauma. Arch Surg 2004, 139(12):, 1278-85; discussion 1285.
• [23]Turegano-Fuentes F, Caba-Doussoux P, Jover-Navalon JM, Martin-Perez E, Fernandez-Luengas D, Diez-Valladares L, Perez-Diaz D, Yuste-Garcia P, Guadalajara Labajo H, Rios-Blanco R, Hernando-Trancho F, Garcia-Moreno Nisa F, Sanz-Sanchez M, Garcia-Fuentes C, Mar-tinez-Virto A, Leon-Baltasar JL, Vazquez-Estevez J: Injury patterns from major urban terrorist bombings in trains: the Madrid experience. World J Surg 2008, 32(6):1168-75.
• [24]Lipsky AM, Gausche-Hill M, Henneman PL, Loffredo AJ, Eckhardt PB, Cryer HG, de Virgilio C, Klein SL, Bongard FS, Lewis RJ: Prehospital hypotension is a predictor of the need for an emergent, therapeutic operation in trauma patients with normal systolic blood pressure in the emergency department. J Trauma 2006, 61(5):1228-33.
• [25]Almogy G, Mintz Y, Zamir G, Bdolah-Abram T, Elazary R, Dotan L, Faruga M, Rivkind AI: Suicide bombing attacks: can external signs predict internal injuries? Ann Surg 2006, 243(4):541-6.
• [26]Almogy G, Luria T, Richter E, Pizov R, Bdolah-Abram T, Mintz Y, Zamir G, Rivkind AI: Can external signs of trauma guide management?: Lessons learned from suicide bombing attacks in Israel. Arch Surg 2005, 140(4):390-3.
• [27]Frykberg ER: Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma 2002, 53(2):201-12.
• [28]Walcher F, Weinlich M, Conrad G, Schweigkofler U, Breitkreutz R, Kirschning T, Marzi I: Prehospital ultrasound imaging improves management of abdominal trauma. Br J Surg 2006, 93(2):238-42.
• [29]Rozycki GS, Ballard RB, Feliciano DV, Schmidt JA, Pennington SD: Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg 1998, 228(4):557-67.
• [30]Soyuncu S, Cete Y, Bozan H, Kartal M, Akyol AJ: Accuracy of physical and ultrasonographic examinations by emergency physicians for the early diagnosis of intraabdominal haemorrhage in blunt abdominal trauma. Injury 2007, 38(5):564-9.
• [31]Dolich MO, McKenney MG, Varela JE, Compton RP, McKenney KL, Cohn SM: 2,576 ultrasounds for blunt abdominal trauma. J Trauma 2001, 50(1):108-12.
• [32]Abbreviated Injury Scale (AIS) 2005 Manual: Association for the Advancement of Automotive Medicine (AAAM). 2005.
• [33]Körner M, Krotz M, Kanz KG, Pfeifer KJ, Reiser M, Linsenmaier U: Development of an accelerated MSCT protocol (Triage MSCT) for mass casualty incidents: comparison to MSCT for single-trauma patients. Emerg Radiol 2006, 12(5):203-9.