Using critical administration thresholds to predict abbreviated laparotomy

Stephanie A. Savage, Joshua J. Sumislawski, Martin Croce, Ben L. Zarzaur

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

BACKGROUND: Early identification of trauma patients requiring abbreviated laparotomy (AL) is key to prevent prolonged operative times with associated hypothermia and acidosis. The critical administration threshold (CAT) is a novel method to define largevolume transfusion, accounting for rate and volume simultaneously. CAT may also serve as a simple trigger to distinguish patients benefiting from AL. The purpose of this study was to determine if CAT was predictive of the need for AL.

METHODS: Trauma patients receiving at least 1 U of blood during Day 1 of admission were eligible. Patients were classified by the number of times they met CAT (≥3 U of blood in 1 hour) for 24 hours. Basic demographics, time to CAT+ status and completion of operative therapy, need for AL, and mortality were quantified. A multivariate Cox proportional hazard ratio with a time-varying covariate was used to compare CAT and AL.

RESULTS: One hundred sixty-nine patients were included (70% new Injury Severity Score [ISS] > 10, 83% male). Significantly more AL patients (79%) were CAT+ compared with the patients with closed fascia (36%, p < 0.0001), and 94% of the patients reached CAT+ status before the end of their operative therapy (mean time to CAT+ status, 163 minutes; mean end operative time, 356 minutes). A Cox proportional hazard ratio demonstrated a nearly threefold increased risk for AL when a patient was CAT+ (odds ratio, 2.723; 95% confidence interval, 1.256-5.906). Failure to opt for an open abdomen with increasing CAT+ status was associated with a trend toward higher mortality.

CONCLUSION: Severely injured patients requiring large-volume transfusions typically reach the first CAT threshold quickly, on average, in less than 3 hours. Further, CAT+ patients have a higher odds of AL and a trend toward greater mortality if time is taken to close the fascia. As such, CAT+ status serves as a logical early trigger to identify patients benefiting from AL.

LEVEL OF EVIDENCE: Therapeutic outcome study, level III.

Original languageEnglish (US)
Pages (from-to)599-603
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume77
Issue number4
DOIs
StatePublished - Oct 1 2014

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Laparotomy
Fascia
Operative Time
Mortality
Injury Severity Score
Wounds and Injuries
Acidosis
Hypothermia
Abdomen
Therapeutics
Odds Ratio
Demography
Outcome Assessment (Health Care)
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Using critical administration thresholds to predict abbreviated laparotomy. / Savage, Stephanie A.; Sumislawski, Joshua J.; Croce, Martin; Zarzaur, Ben L.

In: Journal of Trauma and Acute Care Surgery, Vol. 77, No. 4, 01.10.2014, p. 599-603.

Research output: Contribution to journalArticle

Savage, Stephanie A. ; Sumislawski, Joshua J. ; Croce, Martin ; Zarzaur, Ben L. / Using critical administration thresholds to predict abbreviated laparotomy. In: Journal of Trauma and Acute Care Surgery. 2014 ; Vol. 77, No. 4. pp. 599-603.
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AB - BACKGROUND: Early identification of trauma patients requiring abbreviated laparotomy (AL) is key to prevent prolonged operative times with associated hypothermia and acidosis. The critical administration threshold (CAT) is a novel method to define largevolume transfusion, accounting for rate and volume simultaneously. CAT may also serve as a simple trigger to distinguish patients benefiting from AL. The purpose of this study was to determine if CAT was predictive of the need for AL.METHODS: Trauma patients receiving at least 1 U of blood during Day 1 of admission were eligible. Patients were classified by the number of times they met CAT (≥3 U of blood in 1 hour) for 24 hours. Basic demographics, time to CAT+ status and completion of operative therapy, need for AL, and mortality were quantified. A multivariate Cox proportional hazard ratio with a time-varying covariate was used to compare CAT and AL.RESULTS: One hundred sixty-nine patients were included (70% new Injury Severity Score [ISS] > 10, 83% male). Significantly more AL patients (79%) were CAT+ compared with the patients with closed fascia (36%, p < 0.0001), and 94% of the patients reached CAT+ status before the end of their operative therapy (mean time to CAT+ status, 163 minutes; mean end operative time, 356 minutes). A Cox proportional hazard ratio demonstrated a nearly threefold increased risk for AL when a patient was CAT+ (odds ratio, 2.723; 95% confidence interval, 1.256-5.906). Failure to opt for an open abdomen with increasing CAT+ status was associated with a trend toward higher mortality.CONCLUSION: Severely injured patients requiring large-volume transfusions typically reach the first CAT threshold quickly, on average, in less than 3 hours. Further, CAT+ patients have a higher odds of AL and a trend toward greater mortality if time is taken to close the fascia. As such, CAT+ status serves as a logical early trigger to identify patients benefiting from AL.LEVEL OF EVIDENCE: Therapeutic outcome study, level III.

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