Abstract | April 5, 2022

A Fast Pass for Motor Vehicle Accident Patients: Expediting Time to Surgery Reduces Their Mortality

Presenting Author: Magnus Jaam-Fung Chun, BS, Medical Student, 3rd Year, Surgery, Tulane University School of Medicine, New Orleans, LA

Coauthors: Magnus Chun, BS, Surgery, MS3, Tulane University School of Medicine, New Orleans, LA; Yichi Zhang, BS, Surgery, MS3, Tulane University School of Medicine, New Orleans, LA; Valeria Noguera, MS, Surgery, MS2, Tulane University School of Medicine, New Orleans, LA; Chad Becnel, MD, MBA, Surgery, PGY2, Tulane University School of Medicine, New Orleans, LA; Tommy Brown, MD, Surgery, Trauma Fellow, Mass General Hospital, Boston, MA; Mohamed Hussein, MD, Surgery, Professor, Tulane University School of Medicine, New Orleans, LA; Eman Toraih, MD, PhD, MSc, Surgery, Professor, Tulane University School of Medicine, New Orleans, LA; Chrissy Guidry DO, Surgery, Associate Program Director, Tulane University School of Medicine, New Orleans, LA; Sharven Taghavi MD, MPH, Surgery, Professor, Tulane University School of Medicine, New Orleans, LA; Rebecca Schroll, MD, Program Director, Tulane University School of Medicine, New Orleans, LA; Juan Duchesne, MD, Surgery, Professor, Tulane University School of Medicine, New Orleans, LA; Patrick McGrew, Surgery, Clerkship Director, Tulane University School of Medicine, New Orleans, LA

Learning Objectives

  1. Trauma centers should develop protocols for expeditious triage from the trauma bay to the OR.

Introduction: Studies have shown that direct admission to operating room (OR) can reduce mortality in trauma patients. We hypothesize that expediting direct admin to OR resuscitation time for specific mechanisms of injuries (MOIs), especially for motor vehicle accident (MVA) patients, will improve overall mortality.

Methods: We performed a retrospective analysis of our trauma registry at a Level 1 Trauma center from 2016 to 2020 and examined time-segment data (maximum 24 hours) from ED arrival to death. All patients were included regardless of MOIs (penetrating and blunt). Multivariate logistic regression was performed and the results were presented as odds ratio with 95% confidence intervals, and p values (statistical significance was set at p<0.05).

Results: A total of 738 patients met study criteria (mean age=35.7±15.6 years with 84% males). Patients admitted for MVA had the highest overall mortality rate (37.5%, p<0.001) and the longest ED-to-OR time (52±20 minutes, p<0.001) compared to those admitted for other MOIs (including both penetrating and blunt). The MVA cohort also experienced the shortest OR start-to-death time (109±24 minutes, p=0.04) compared to other MOI cohorts. MVA multivariate analysis showed that patients with a longer direct admin to OR resuscitation had a higher risk of mortality (OR=1.03, 95%CI: 1.01-1.07, p=0.01) (Figure 1). Other significant variables found to be associated with mortality/survival included obesity (OR=3.24, 95%CI: 1.13-9.34, p=0.029) and hypotensive on arrival (OR=3.37, 95%CI: 1.50-7.59).

Conclusions: Consideration of direct admin to OR resuscitation should be given to trauma patients. In addition, trauma centers should develop protocols for expeditious triage from the trauma bay to the OR.

Posted in: Surgery & Surgical Specialties35