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


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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.



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Published 01 January 2009
Reads 33
Language English


532 EUr J Med ReS (2009) 14: 532-540
EuRoPEan JouRnal of MEDIcal REsEaRcH
DeCember 14, 2009
© I. HOLzàpFeL PUbLiSherS 2009
DuRatIon anDPREDIctoRs ofEMERgEncysuRgIcaloPERatIonsBasIs foRMEDIcalManagEMEnt ofMass casualtyIncIDEnts
1 21 11 11 s. HUber-WàGNer, R. leFeriNG, M. V. KàY, J. sTeGmàier, P. n. KhàLiL, a. o. PàUL, P. BiberThàLer, 1 1 W. MUTSChLer, K.-g. KàNz, ON behàLFOF TheWOrkiNG grOUp ON POLYTràUmà (nIs) OFThe germàN tràUmà sOCieTY (Dgu)*
1 MUNiCh uNiverSiTY HOSpiTàL, DepàrTmeNT OF tràUmà sUrGerY – càmpUS INNeNSTàdT, lUdwiG-MàximiLiàNS-uNiverSiTY MUNiCh,germàNY 2 IfoM – INSTiTUTe FOr ReSeàrCh iN operàTive MediCiNe, uNiverSiTY WiTTeN/HerdeCke, fàCULTY OF MediCiNe, cOLOGNe, germàNY
Abstract Backgr ound:HOSpiTàLS hàve à CriTiCàLLY impOrTàNT rOLe iN The màNàGemeNT OFmàSS CàUSàLiTY iNCideNTS (McI), YeT There iS LiTTLe iNFOrmàTiON TO àSSiST emerGeNCY pLàN-NerS. a SiGNiFiCàNTLY LimiTiNG FàCTOr OFà hOSpiTàL’S Cà-pàbiLiTY TO TreàT ThOSe àFFeCTed iS iTS SUrGiCàL CàpàCiTY. We ThereFOre iNTeNded TO prOvide dàTà àbOUT The dUrà-TiON àNd prediCTOrS OFLiFe SàviNG OperàTiONS. Methods:20,815 predOmiNàNTLY bLUNTthe dàTà OF TràUmà pàTieNTS reCOrded iN The tràUmà ReGiSTrY OF The germàN-tràUmà-sOCieTY wàS reTrOSpeCTiveLY àNà-LYzed TO CàLCULàTe The dUràTiON OFLiFe-SàviNG Operà-TiONS àS weLL àS Their prediCTOrS. INCLUSiON CriTerià were àN Iss≥16 àNd The perFOrmàNCe OFreLevàNT IcPM-COded prOCedUreS wiThiN 6h OFàdmiSSiON. Results:frOm 1,228 pàTieNTS FULFiLLiNG The iNCLUSiON CriTerià 1,793 OperàTiONS COULd be ideNTiFied àS LiFe-Sàv-iNG OperàTiONS. aCUTe iNjUrieS TO The àbdOmeN àC-COUNTed FOr 54.1% FOLLOwed bY heàd iNjUrieS (26.3%), peLviC iNjUrieS (11.5%), ThOràCiC iNjUrieS (5.0%) àNd màjOr àmpUTàTiONS (3.1%). the meàN CUT TO SUTUre Time wàS 130miN (IQR 65-165miN). lOGiSTiC reGreS-SiON reveàLed 8 vàriàbLeS àSSOCiàTed wiTh àN emerGeNCY OperàTiON: aIs OFàbdOmeN ≥3 (oR 4,00), Iss ≥35 (oR 2,94), hemOGLObiN LeveL ≤8 mG/dl (oR 1,40), pULSe ràTe ON hOSpiTàL àdmiSSiON <40 Or >120/miN (oR 1,39), bLOOd preSSUre ON hOSpiTàL àdmiSSiON<90 mmHG (oR 1,35), prehOSpiTàL iNFUSiON vOLUme ≥2000 mL (oR 1,34), gcs ≤8 (oR 1,32) àNd àNiSOCOrià (oR 1,28) ON-SCeNe. Conclusions:130miN CàL-the meàN OperàTiON Time OF CULàTed FOr emerGeNCY LiFe-SàviNG SUrGiCàL OperàTiONS prOvideS à reàLiSTiC GUideLiNe FOr The prOSpeCTive TreàT-meNT CàpàCiTY whiCh CàN be eSTimàTed àNd prOjeCTed iNTO àN àCTUàL iNCideNT àdmiSSiON CàpàCiTY. KNOwLedGe OF prediCTiveFàCTOrS FOr LiFe-SàviNG emerGeNCY Operà-TiONS heLpS TO ideNTiFY ThOSe pàTieNTS ThàT Need mOST UrGeNT OperàTive TreàTmeNT iN CàSe OFbLUNT McI.
Key words:MULTipLe CàSUàLTY iNCideNTS, MàSS CàSUàLTY iNCideNT, McI, triàGe, EmerGeNCY OperàTiON, liFeSàv-iNG prOCedUre, EmerGeNCY pLàNNiNG, DiSàSTer mediCiNe
1. IntRoDuctIon
a màSS CàSUàLTY iNCideNT (McI) iS àN iNFreqUeNT eveNT ThàT reqUireS COOrdiNàTed àCTiON UNder Time CON-STràiNTS [1]. IN The LàST YeàrS, beSide NàTUràL diSàSTerS, TràNSpOrTàTiONS àNd STrUCTUre FàiLUre iNCideNTS, TerrOr-iST bOmbiNGS hàve emerGed TO be à pàrTiCULàrLY devàS-TàTiNG àNd mediCàLLY ChàLLeNGiNG TYpe OFà McI [2, 3]. the SUddeN iNFLUx OFpàTieNTS SeekiNG SimiLàr mediCàL iNTerveNTiONS STràiNS CriTiCàL hOSpiTàL FàCiLiTieS àNd re-SOUrCeS [1]. aSide FrOm iNCideNT SCeNe OperàTiONS SUCh àS TriàGe TreàTmeNT àNd TràNSpOrT, hOSpiTàL OperàTiONS SUCh àS TràUmà rOOm reSUSCiTàTiON, COmpUTed TOmOGràphY (ct) àNd The iNTeNSive Càre UNiT (Icu) CàpàCiTY, àNOTh-er màjOr bOTTLeNeCk iN The màNàGemeNT OFà màSS Cà-SUàLTY iNCideNT (McI) iS OperàTiONàL SUrGiCàL TreàTmeNT CàpàCiTY [1, 4, 5]. DeSpiTe The SiGNiFiCàNCe OFThiS re-STriCTiON iN à ChàiN OFprOCeSSeS, There iS LiTTLe dàTà àvàiL-àbLe iN The LiTeràTUre àbOUT The dUràTiON Or prediCTOrS. PrediCTive reSOUrCe pLàNNiNG iS àN impOrTàNT FàCTOr iN riSk màNàGemeNT. fOr pLàNNerS TO CONdUCT SCeNàriO àNàLYSiS àNd deveLOp OperàTiONàL prOCedUreS, bàSiC pà-ràmeTerS àre eSSeNTiàL [6]. aT The eNTiTY LeveL, The iN-hOSpiTàL màNàGemeNT OFà McI mUST Tàke The NUmber OF àvàiLàbLeSUrGiCàL OperàTiON TeàmS àS weLL àS The ex-peCTed dUràTiON OFLiFe-SàviNG emerGeNCY OperàTiONS iNTO àCCOUNT [4]. fUrThermOre iT iS impOrTàNT TO CON-Sider ThàT Time OFThe iNCideNT hàS pOTeNTiàL impàCT ON The àvàiLàbiLiTY OFperSONNeL àNd ThereFOre ON The TreàTmeNT CàpàCiTY OFTràUmà CeNTerS. oUTSide OFNOr-màL OperàTiNG hOUrS The SiTUàTiON hàS TO be màNàGed iNiTiàLLY bY iN-hOUSe àNd reGULàr bàCkGrOUNd STàFFONLY. aT LOCàL, STàTe àNd FederàLS LeveLS iNdiCàTiONS OFhOw àNd wheN àN emerGeNCY reSpONSe SYSTem màY be Over-wheLmed CàN heLp pLàN iNveSTmeNT àNd emerGeNCY re-SpONSe pOLiCY. the GOàL OFThiS STUdY iS TO àNàLYze The dàTà COLLeCT-ed bY The tràUmà ReGiSTrY OFThe germàN tràUmà sO-CieTY àNd CàLCULàTe The meàN dUràTiON àNd diSTribUTiON pàTTerN OFLiFe-SàviNG OperàTiONS àS weLL àS Their prediC-TOrS. thiS iNFOrmàTiON iS OFpOTeNTiàL USe iFONe àS-