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Emergency Department Versus Operating Suite Intubation in Operative Trauma Patients: Does Location Matter?

  • R. P. DumasEmail author
  • D. Jafari
  • S. A. Moore
  • L. Ruffolo
  • D. N. Holena
  • M. J. Seamon
Original Scientific Report

Abstract

Background

Decreasing the time from patient arrival to definitive surgical care in injured patients requiring an operation improves outcomes. We sought to study the effect of intubation location (emergency department versus operating suite) on time to definitive surgical care. We hypothesized that patients requiring emergency surgical interventions intubated in the emergency department would have shorter times to definitive care when compared to patients intubated in the operating suite.

Methods

All injured patients with a preoperative emergency department dwell time of less than 30 min and undergoing emergency operative procedures with the trauma surgery service at an urban Level I center (2010–2017) were analyzed. Demographics, clinical variables, and outcomes were assessed in relation to emergency department intubation versus operating suite intubation. The primary study endpoint was time to initiation of definitive surgical care, defined as the total elapsed time from emergency department arrival until operating room incision time. To investigate the relationship between clinical variables and time, multivariable regression was performed.

Results

In total, 241 patients were included. In total, 138 patients were intubated in the emergency department and 103 patients were intubated in the operative suite. There was no difference between patients intubated in the emergency department and those intubated in the operating room with respect to age, gender, injury mechanism, initial heart rate or systolic blood pressure. Emergency department patients were more likely to sustain post-intubation, traumatic cardiopulmonary arrest (8.0 vs. 0.9%; p = 0.014). No statistical difference in total elapsed time from arrival to definitive surgical care was appreciated between study groups (41 vs. 43 min; p = 0.064). After controlling for clinical variables, emergency department intubation was not associated with time to definitive care (p = 0.386) in the multiple variable regression analysis.

Conclusion

When emergency department and operative suite intubation patients were compared, emergency department intubation did not decrease total elapsed time until definitive surgery but was associated with post-intubation, traumatic cardiopulmonary arrest.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

None

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • R. P. Dumas
    • 1
    Email author
  • D. Jafari
    • 2
    • 3
  • S. A. Moore
    • 4
  • L. Ruffolo
    • 5
  • D. N. Holena
    • 2
    • 6
  • M. J. Seamon
    • 2
  1. 1.Division of General and Acute Care Surgery, Department of SurgeryUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Division of Traumatology, Surgical Critical Care and Emergency SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Emergency MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of SurgeryUniversity of New MexicoAlbuquerqueUSA
  5. 5.Department of SurgeryUniversity of Rochester Medical CenterRochesterUSA
  6. 6.Center for Clinical Epidemiology and BiostatisticsUniversity of PennsylvaniaPhiladelphiaUSA

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