| アブストラクト | PURPOSE: Trauma remains a major contributor to global disability. While the trauma laparotomy can be a life-saving procedure in abdominal injury, a select proportion are performed with no pathology identified intra-operatively, potentially exposing patients to unnecessary morbidity. We aimed to assess the global prevalence of negative laparotomy and identify any influencing factors at both the patient- and system-level. METHODS: This was a secondary analysis of the GOAL-Trauma study, a multicentre prospective international observational study on trauma laparotomy patients, conducted from April to December 2024. We defined a negative laparotomy as where no intra-abdominal injuries were identified during the index operation. A multivariable logistic regression was performed to identify predictive factors for a negative laparotomy. RESULTS: Of the 1769 patients included, 128 patients (7.2%) underwent a negative laparotomy. Regression analysis demonstrated that a penetrating mechanism of injury (OR 2.37, CI:1.53-3.69, p < 0.001) and a lower grade of surgeon (surgical registrar relative to consultant - OR 2.91, CI:1.90-4.47, p < 0.001) were independent predictors for negative laparotomy. Neither human development index nor hospital resource level impacted negative laparotomy rates. CONCLUSION: One in every fourteen trauma laparotomies performed in our global cohort was negative, with injury type and surgeon experience having a significant deterministic role. As trauma systems develop globally, recognition in the value of both training and a structured assessment pathway is paramount. The rate of negative trauma laparotomy, either institutionally or regionally, may act as a useful benchmark of trauma system performance and warrants further exploration. |
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| 投稿者 | Laird, William L A; Bath, Michael F; Amoako, Joachim; Wohlgemut, Jared; Nuno-Guzman, Carlos M; Khajanchi, Monty; Smith, Brandon G; Hobbs, Laura; Perkins, Zane B; Weiser, Thomas G; Hardcastle, Timothy C; Bashford, Tom |
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| 組織名 | International Health Systems Group, Department of Engineering, University of;Cambridge, Cambridge, UK.;Cambridge, Cambridge, UK. mb2583@cam.ac.uk.;University of Ghana Medical School, Accra, Ghana.;Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana.;Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London,;London, UK.;Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS;Foundation Trust, Birmingham, UK.;Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.;Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara,;Guadalajara, Jalisco, Mexico.;Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital,;Mumbai, India.;Department of Anaesthesia, East & North Hertfordshire NHS Trust, Stevanage, UK.;NIHR Global Health Research Group on Acquired Brain and Spine Injury, Cambridge,;UK.;Major Trauma Service, Royal London Hospital, Barts Health NHS Trust, London, UK.;Department of Surgery, Stanford University, Palo Alto, CA, USA.;Trauma and Burns Unit, KwaZulu-Natal Department of Health, Inkosi Albert Luthuli;Central Hospital, Durban, 4058, South Africa.;Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine;(NRMSM), University of KwaZulu-Natal, Durban, 4000, South Africa.;Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust,;Cambridge, UK. |
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