Trauma patients requiring abdominal operation have considerable morbidity and mortality, yet no specific quality indicators are measured in the trauma systems of the UK.
The Trauma Emergency Laparotomy Audit (TELA) aimed to address this gap in data collection. TELA aimed at describing the characteristics and outcomes of patients undergoing emergency abdominal operation and key processes of care.
TELA was the first study run and published by the NaTRIC collaborative. It was conceived in June 2018, data collection ran for the first six months of 2019, involving all of the major trauma centers in the UK, and it was published in September 2021.
Patients of any age undergoing laparotomy or laparoscopy within 24 hours of injury were included. Existing standards for related emergent conditions were used. The study included 363 patients from 34 hospitals. The majority were young men with no comorbidities who required operation to control bleeding (51%). More than 90% received attending-delivered care in the emergency department (318 of 363) and operating room (321 of 363). The overall mortality rate was 9%. Patients with blunt trauma had a greater risk of death compared with patients with penetrating injuries (16.6% vs 3.8%; risk ratio 4.3; 95% CI, 2.0 to 9.4). Patients in which the Major Hemorrhage Protocol (MHP) was activated and who received a blood transfusion (n = 154) constituted a high-risk subgroup, accounting for 45% of the study cohort but 97% of deaths and 96% of blood components transfused. The MHP subgroup had expedited timelines from emergency department arrival to knife to skin (MHP: median 119 minutes [interquartile range 64 to 218 minutes] vs no MHP: median 211 minutes [interquartile range 135 to 425 minutes]; p < 0.001).
The majority of trauma patients requiring emergency abdominal operation received a high standard of expedited care in a maturing national trauma system. Despite this, mortality and resource use among high-risk patients remained considerable.
TELA demonstrated that trainee led research in the UK could be achieved and could deliver important findings. The study won first place in the American College of Surgeons, Committee on Trauma Resident’s Research Prize. This was the first time the award had been given to the British.
For more information, follow the TELAStudy Twitter account on @tela_natric
The recent publication can be found Here
