Trauma laparotomy in a rural setting before transfer to a regional center: does it save lives?

J Trauma. 2003 May;54(5):823-6; discussion 826-8. doi: 10.1097/01.TA.0000063001.61469.3E.

Abstract

Background: In the rural setting, long distances may necessitate that a patient undergo emergency laparotomy before transfer to a regional trauma center for definitive management. The purpose of this study was to review the experience of three regional trauma centers with such treated patients.

Methods: This study was a retrospective chart review of patients who underwent emergency laparotomy for trauma before transfer, identified from the respective databases of participating centers over a 6-year period.

Results: Fifty-six patients met the study criteria. Twenty-six (46%) were transferred primarily for management of the abdominal injury, and 14 of these patients (25% overall) underwent damage control procedures. Overall survival was 82%. Logistic regression demonstrated that transfer for treatment of the extra-abdominal injury was the only significant predictor of survival (odds ratio, 34.33; 95% confidence interval, 1.80-655.24).

Conclusion: Although patients undergoing laparotomy who were subsequently transferred for management of abdominal injury have reasonable outcome, patients transferred primarily for management of extra-abdominal injury seem to have a survival advantage.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Injuries / classification
  • Abdominal Injuries / mortality
  • Abdominal Injuries / surgery*
  • Adolescent
  • Adult
  • Aged
  • Child
  • Emergency Treatment*
  • Female
  • Humans
  • Laparotomy
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Transfer*
  • Regional Medical Programs
  • Retrospective Studies
  • Rural Health Services*
  • Survival Analysis
  • Trauma Severity Indices