Use of vital signs in Predicting surgical intervention in a South African population: A cross-sectional study

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Use of vital signs in Predicting surgical intervention in a South African population: A cross-sectional study

JournalInternational Journal of Surgery
Publication date – May – 2020
Authors – Amee D.Azad, Victor Y.Kong, Damian L.Clark, Grant L.Laing, John L.Bruce, Tiffany E.Chao
Keywordsgender mechanism, gunshot, RTS(revised trauma score), sex disparities, South Africa, stab, surgery, trauma, vital signs
Open access – Yes
SpecialityEmergency surgery, Trauma surgery
World region Southern Africa
Country: South Africa
Language – English
Submitted to the One Surgery Index on June 1, 2020 at 1:41 pm
Abstract:

Background
While vital signs are widely obtained for trauma patients around the world, the association of these signs with need for surgical intervention has yet to be defined. Early detection of preventable outcomes is essential to timely intervention and reduction of morbidity and mortality.

Objective
The aim of this study was to determine the association of vital signs and surgical intervention in a population of patients in South Africa.

Methods
This retrospective cohort included 8722 trauma patients admitted at **** Hospital in Pietermaritzburg, South Africa over a five-year period December 2012-April 2018. Exclusion criteria included missing key data points. Variables for analysis included sex, mechanism of injury, admission Glasgow Coma Scale (GCS), systolic blood pressure, diastolic blood pressure, temperature, heart rate, and respiratory rate. Surgical intervention was defined by the need for treatment requiring time in the operating room. Data were analyzed using a univariate and multivariate logistic regression to determine an association between admission vital signs and surgical intervention and compared to the association of the Revised Trauma Score to surgical intervention.

Results
Of the 8722 trauma patient records available, exclusion of patients with incomplete data resulted in 7857 patient records available for analysis. Two thousand two hundred and ninety-six (29.2%) patients required surgical intervention in the operating room. Multivariate analysis revealed that male sex [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.06-1.48], stab wound (OR 3.42, CI 2.99-3.09), gunshot wound (OR 4.27, CI 3.58-5.09), systolic hypotension (OR 1.81, CI 1.32- 2.48), hypothermia(OR 1.77, CI 1.34-2.34), tachycardia (OR 1.84, CI 1.61- 2.10), and tachypnea (OR 1.26, CI 1.08-1.45) as factors ssociated withan increased likelihood of surgical intervention.

Conclusions
In this cohort of patients, the need for surgical intervention was best predicted by penetrating mechanisms of injury, tachycardia, and systolic hypotension. These data show that rapid and focused patient assessments should be used to triage patients foremergency surgery to avoid delays at any stage.

OSI Number – 20480

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