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 large-volume 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.
BACKGROUND: Early identification of traumapatients 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 large-volume 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:Traumapatients 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 ALpatients (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.
Authors: Derek J Roberts; Niklas Bobrovitz; David A Zygun; Andrew W Kirkpatrick; Chad G Ball; Peter D Faris; Henry T Stelfox Journal: World J Emerg Surg Date: 2021-03-11 Impact factor: 5.469