Trauma Hybrid Operating Room (THOR) shortened procedure time in abdominopelvic trauma patients requiring surgery and interventional radiology procedures

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Abstract

Abdominopelvic injuries are common, and bleeding occurring in both cavities requires various bleeding control techniques i.e., laparotomy, angiographic embolization (AE), and orthopedic fixation. Hence, the use of Trauma Hybrid Operating Room (THOR) in abdominopelvic injuries has theoretical advantages including rapid bleeding control and minimizing patient transportation. The objective of the present study is to evaluate the impact of THOR in abdominopelvic injuries.

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Most cited references 18

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Pelvic fractures: value of plain radiography in early assessment and management.

J Young, A R Burgess, R Brumback … (1986)

Assessment of pelvic fractures in severely traumatized, clinically unstable patients presents a diagnostic problem. Traditional plain-radiographic classifications of the fracture are of limited preoperative value to the surgeon who must apply corrective force in opposition to the original force vector causing the fracture. Computed tomographic scanning is an effective method of examining the pelvis but is time consuming and may be impractical in cases of severe injury. In a retrospective analysis of the plain radiographs of 142 cases of pelvic fracture, four patterns of force were identified, presenting distinctive, recognizable radiographic appearances. These patterns are anteroposterior compression, lateral compression, vertical shear, and a complex pattern. The resulting classification of pelvic fracture, based on radiographic and clinical findings, correlates with associated injury to soft-tissue structures and enables the surgeon to begin corrective procedures rapidly.

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Western Trauma Association Critical Decisions in Trauma: Management of pelvic fracture with hemodynamic instability-2016 updates.

Thai Tran, Karen J. Brasel, Riyad Karmy-Jones … (2016)

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Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps.

Juan Asensio, Gustavo Roldán, Patrizio Petrone … (2003)

American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) grades IV and V complex hepatic injuries are highly lethal. Our objectives were to review experience and identify predictors of outcome and to evaluate the role of angioembolization in decreasing mortality. This was a retrospective 8-year study of all patients sustaining AAST-OIS grades IV and V hepatic injuries managed operatively. Statistical analysis was performed using univariate and multivariate logistic regression. The main outcome measure was survival. The study included 103 patients, with a mean Revised Trauma Score of 5.61 +/- 2.55 and a mean Injury Severity Score of 33 +/- 9.5. Mechanism of injury was penetrating in 80 (79%) and blunt in 23 (21%). Emergency department thoracotomy was performed in 21 (25%). AAST grade IV injuries occurred in 51 (47%) and grade V injuries occurred in 52 (53%). Mean estimated blood loss was 9,414 mL. Overall survival was 43%. Adjusted overall survival rate after emergency department thoracotomy patients were excluded was 58%. Results stratified to AAST-OIS injury grade were as follows: grade IV, 32 of 51 (63%); grade V, 12 of 52 (23%); grade IV versus grade V (p < 0.001) odds ratio, 2.06; 95% confidence interval, 2.72 (1.40-3.04). Logistic regression analysis identified as independent predictors of outcome Revised Trauma Score (adjusted p < 0.0002), angioembolization (adjusted p < 0.0177), direct approach to hepatic veins (adjusted p < 0.0096), and packing (adjusted p < 0.0013). Improvements in mortality can be achieved with an appropriate operative approach. Angioembolization as an adjunct procedure decreases mortality in AAST-OIS grades IV and V hepatic injuries.

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Kritaya Kritayakirana: (View ORCID Profile)

Natawat Narueponjirakul: (View ORCID Profile)

Nantiskarn Chanpen: (View ORCID Profile)

Journal

Title: Injury

Abbreviated Title: Injury

Publisher: Elsevier BV

ISSN (Print): 00201383

Publication date Created: February 2023

Publication date (Print): February 2023

Volume: 54

Issue: 2

Pages: 513-518

Article

DOI: 10.1016/j.injury.2022.11.004

PubMed ID: 36371314

SO-VID: b2928bc4-0376-4911-bbc3-791077e7c692

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https://doi.org/10.15223/policy-017

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https://doi.org/10.15223/policy-012

https://doi.org/10.15223/policy-029

https://doi.org/10.15223/policy-004

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Trauma Hybrid Operating Room (THOR) shortened procedure time in abdominopelvic trauma patients requiring surgery and interventional radiology procedures

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Most cited references 18

Pelvic fractures: value of plain radiography in early assessment and management.

Western Trauma Association Critical Decisions in Trauma: Management of pelvic fracture with hemodynamic instability-2016 updates.

Operative management and outcomes in 103 AAST-OIS grades IV and V complex hepatic injuries: trauma surgeons still need to operate, but angioembolization helps.

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