Propensity matched analysis of DPA or DPL used within the first hour for severely hypotensive blunt trauma patients

Abstract

Background

Prior single-center reports advocate for use of diagnostic peritoneal aspiration or lavage (DPA/DPL) to identify blunt trauma patients (BTPs) with intra-abdominal hemorrhage who require emergent surgery. Despite this, concerns exist over the potential for DPA/DPL to delay transfer to the operating room (OR). We hypothesized that DPA/DPL application in severely hypotensive BTPs would lead to increased OR transfer time and in-hospital mortality.

Methods

The 2017–2019 TQIP database was queried for adult BTPs presenting with severe hypotension (systolic blood pressure <70 mmHg) who underwent any operative intervention within two-hours. Using a 1:2 propensity-score model, patients who underwent DPA/DPL within one-hour of arrival were compared with those who did not, controlling for age, sex, comorbidities, ≥6 units of packed red cells within 4 h, and injury profile.

Results

From 5514 patients, 62 (1.1 %) underwent DPA/DPL. We matched 52 DPA/DPL patients to 104 patients not undergoing DPA/DPL. There were no differences in the matched variables between cohorts (all p > 0.05). Compared to those not undergoing DPA/DPL, patients undergoing DPA/DPL had a higher rate/risk of in-hospital complications (59.6 % vs. 39.4 %, p = 0.02) (OR 2.27, CI 1.15–4.47, p = 0.02) but statistically similar rate/risk of death (65.4 % vs. 50.0 %, p = 0.07) (OR 1.89, CI 0.95–3.76, p = 0.07). Time to OR was similar between both groups (DPA/DPL 39 min vs. non-DPA/DPL 42 min, p = 0.87).

Conclusion

DPA or DPL used within the first hour of arrival does not appear to delay time to OR and does not increase risk of death. This challenges concerns over potential DPA/DPL-associated delays and heightened mortality risks.