Top

Published in:

Open Access 01-12-2018 | Research article

Is case triaging a useful tool for emergency surgeries? A review of 106 trauma surgery cases at a level 1 trauma center in South Africa

Authors: Sharfuddin Chowdhury, Andrew John Nicol, Mahammed Riyaad Moydien, Pradeep Harkison Navsaria, Luis Felipe Montoya-Pelaez

Published in: World Journal of Emergency Surgery | Issue 1/2018

Abstract

Background

The optimal timing for emergency surgical interventions and implementation of protocols for trauma surgery is insufficient in the literature. The Groote Schuur emergency surgery triage (GSEST) system, based on Cape Triaging Score (CTS), is followed at Groote Schuur Hospital (GSH) for triaging emergency surgical cases including trauma cases. The study aimed to look at the effect of delay in surgery after scheduling based on the GSEST system has an impact on outcome in terms of postoperative complications and death.

Methods

Prospective audit of patients presenting to GSH trauma center following penetrating or blunt chest, abdominal, neck and peripheral vascular trauma who underwent surgery over a 4-month period was performed. Post-operative complications were graded according to Clavien-Dindo classification of surgical complications.

Results

One-hundred six patients underwent surgery during the study period. One-hundred two (96.2%) cases were related to penetrating trauma. Stab wounds comprised 71 (67%) and gunshot wounds (GSW) 31 (29.2%) cases. Of the 106 cases, 6, 47, 40, and 13 patients were booked as red, orange, yellow, and green, respectively. The median delay for green, yellow, and orange cases was within the expected time. The red patients took unexpectedly longer (median delay 48 min, IQR 35–60 min). Thirty-one (29.3%) patients developed postoperative complications. Among the booked red, orange, yellow, and green cases, postoperative complications developed in 3, 18, 9, and 1 cases, respectively. Only two (1.9%) postoperative deaths were documented during the study period. There was no statistically significant association between operative triage and post-operative complications (p = 0.074).

Conclusion

Surgical case categorization has been shown to be useful in prioritizing emergency trauma surgical cases in a resource constraint high-volume trauma center.

Matzopoulos RG, Prinsloo M, Butchart A, et al. Estimating the South African trauma caseload. Int J Inj Control Saf Promot. 2006;13(1):49–51.CrossRef

Wallis LA, Gottschalk SB, Wood D, et al. The cape triage score-a triage system for South Africa. S Afr Med J. 2006;96:53–6.PubMed

Dindo D, Demartines N, Clavien PA. Classification of surgical complications—a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral

Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications—five-year experience. Ann Surg. 2009;250(2):187–96.CrossRefPubMed

Kluger Y, Ben-Ishay O, Sartelli M, et al. World society of emergency surgery study group initiative on timing of acute care surgery classification(TACS). World J Emerg Surg. 2013;8:17. https://doi.org/10.1186/1749-7922-8-17.CrossRefPubMedPubMedCentral

Beveridge R, Ducharme J, Janes L, et al. Reliability of the Canadian emergency department triage and acuity scale: interrater agreement. Ann Emerg Med. 1999;34:155–9.CrossRefPubMed

Australian College of Emergency Medicine. G24 guidelines on the implementation of the Australasian triage scale in emergency departments. Melbourne: Australian College of Emergency Medicine; 2005.

Manchester Triage Group. Emergency triage. Manchester: BMJ Publishing Group; 1997.

Chowdhury S, Navsaria PH, Edu S, et al. The effect of emergency medical services response on the outcome of trauma laparotomy at a level 1 trauma centre in South Africa. S Afr J Surg. 2016;54(4):17–21.PubMed

Title: Is case triaging a useful tool for emergency surgeries? A review of 106 trauma surgery cases at a level 1 trauma center in South Africa
Authors: Sharfuddin Chowdhury
Andrew John Nicol
Mahammed Riyaad Moydien
Pradeep Harkison Navsaria
Luis Felipe Montoya-Pelaez
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: World Journal of Emergency Surgery / Issue 1/2018
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-018-0166-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Is case triaging a useful tool for emergency surgeries? A review of 106 trauma surgery cases at a level 1 trauma center in South Africa

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2018

Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2017 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group

Development of a reconditioning program for elderly abdominal surgery patients: the Elder-friendly Approaches to the Surgical Environment–BEdside reconditioning for Functional ImprovemenTs (EASE-BE FIT) pilot study

Closed Or Open after Source Control Laparotomy for Severe Complicated Intra-Abdominal Sepsis (the COOL trial): study protocol for a randomized controlled trial

A combination of SOFA score and biomarkers gives a better prediction of septic AKI and in-hospital mortality in critically ill surgical patients: a pilot study

Emergency surgeons’ perceptions and attitudes towards antibiotic prescribing and resistance: a worldwide cross-sectional survey

Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care