A national evaluation of emergency department thoracotomy practices: Will a high-risk, low-yield procedure reveal potential management practice bias?
A national evaluation of emergency department thoracotomy practices: Will a high-risk, low-yield procedure reveal potential management practice bias?
复制标题
DOI：
10.1016/j.surg.2021.11.031
复制
发表时间：
2022-07-01
期刊：
影响因子：
3.8
通讯作者：
Ang, Darwin
中科院分区：
文献类型：
--
作者：
Elkbuli, Adel;Fanfan, Dino;Ang, Darwin
背景：急诊科开胸手术常用于创伤性失血过多的濒死病人。因此，内在的偏见可能会发挥作用，在是否急诊科开胸手术进行。我们的目的是调查种族，社会经济地位和性别差异在急诊科开胸手术的使用，并调查这些患者的结果，以评估可能的外科医生的做法bias.Method：美国外科医生学会创伤质量计划参与者使用概况2016-2018年的全国回顾性队列分析。因福尔斯跌倒/火器/机动车碰撞/其他损伤机制继发的钝性、穿透性或其他损伤，并在受伤后无脉搏、有或无生命体征的情况下到创伤中心就诊的成年患者。开胸率、开胸时间、转入手术室、急诊室处置、重症监护室住院时间、住院时间、并发症、死亡率和住院处置。对混杂因素进行单因素分析和校正后的多因素回归分析，P <0.05。结果：共分析了6,453例患者。急诊科开胸手术和死亡率显着较高的少数民族和无保险的患者，即使在风险调整。在急诊科开胸手术的时间上，各种族之间没有差异。白色/白种人患者急诊科最初安排到重症监护室的比率最高（10.3%，P < .0001），死亡率最低（89.2%，P < .0001）。结论：在急诊科无脉患者开胸手术的实践中，未观察到外科医生偏倚。然而，少数民族和社会经济地位较低的患者预后较差。少数民族和社会经济地位较低的患者由于穿透性创伤较多，开胸率较高。(c)2021爱思唯尔公司All rights reserved.
Background: Emergency department thoracotomy is often performed on patients in extremis from traumatic exsanguination. Thus, inherent biases may play a role in whether or not the emergency department thoracotomy is performed. We aimed to investigate race, socioeconomic status, and gender disparities in the use of emergency department thoracotomy and to investigate outcomes of these patients to assess for possible surgeon practice bias.Method: A nationwide retrospective cohort analysis of the American College of Surgeons Trauma Quality Programs Participant Use Profile 2016-2018. Adult patients who suffered blunt, penetrating, or other injuries secondary to falls/firearms/motor vehicle collision/other mechanisms of injury and presented to a trauma center pulseless, with or without signs of life after injury. Rates of thoracotomy, time to thoracotomy, transfer to operating room, emergency department disposition, intensive care unit length of stay, hospital length of stay, complications, mortality, and hospital disposition. Univariate analyses and adjusted multivariable regression were performed to account for confounders with significance defined as P < .05.Results: A total of 6,453 patients were analyzed. Emergency department thoracotomy and mortality were significantly higher in minorities and uninsured patients, even after risk adjustment. There were no differences in timing among race groups to emergency department thoracotomy. White/Caucasian patients experienced the highest rate of emergency department initial disposition to the intensive care unit (10.3%, P < .0001) and lowest mortality rate (89.2%, P < .0001).Conclusion: Surgeon bias was not seen in the practice of emergency department thoracotomy for patients arriving pulseless. However, poorer outcomes were associated with minorities and lower socioeconomic status patients. Thoracotomy rates were higher in minorities and lower socioeconomic status patients due to more penetrating trauma.(c) 2021 Elsevier Inc. All rights reserved.