Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric lschaemia : The Importance of Referral Patterns and Triage

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dc.contributor University of Helsinki, HUS Abdominal Center en
dc.contributor University of Helsinki, HUS Abdominal Center en
dc.contributor University of Helsinki, HUS Abdominal Center en
dc.contributor University of Helsinki, Staff Services en
dc.contributor University of Helsinki, HUS Perioperative, Intensive Care and Pain Medicine en
dc.contributor University of Helsinki, HUS Abdominal Center en
dc.contributor University of Helsinki, HUS Abdominal Center en
dc.contributor University of Helsinki, Staff Services en
dc.contributor.author Lemma, Aurora N.
dc.contributor.author Tolonen, Matti
dc.contributor.author Vikatmaa, Pirkka
dc.contributor.author Mentula, Panu
dc.contributor.author Vikatmaa, Leena
dc.contributor.author Kantonen, Ilkka
dc.contributor.author Leppäniemi, Ari
dc.contributor.author Sallinen, Ville
dc.date.accessioned 2019-11-26T11:42:01Z
dc.date.available 2019-11-26T11:42:01Z
dc.date.issued 2019-06
dc.identifier.citation Lemma , A N , Tolonen , M , Vikatmaa , P , Mentula , P , Vikatmaa , L , Kantonen , I , Leppäniemi , A & Sallinen , V 2019 , ' Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric lschaemia : The Importance of Referral Patterns and Triage ' , European Journal of Vascular and Endovascular Surgery , vol. 57 , no. 6 , pp. 842-849 . https://doi.org/10.1016/j.ejvs.2019.01.002 en
dc.identifier.issn 1078-5884
dc.identifier.other PURE: 128400410
dc.identifier.other PURE UUID: 54e6dfb2-a57e-4cc1-94a6-eafd7f2d880a
dc.identifier.other RIS: urn:9384C4270D56751F8E195D4CEFBA17FE
dc.identifier.other WOS: 000471825900021
dc.identifier.uri http://hdl.handle.net/10138/307455
dc.description.abstract Objectives: Despite modern advances in diagnosis and treatment, acute arterial mesenteric ischaemia (AMI) remains a high mortality disease. One of the key modifiable factors in AMI is the first door to operation time, but the factors attributing to this parameter are largely unknown. The aim of this study was to evaluate the factors affecting delay, with special focus on the pathways to treatment. Methods: This was a single academic centre retrospective study. Patients undergoing intervention for AMI caused by thrombosis or embolism of the superior mesenteric artery between 2006 and 2015 were identified from electronic patient records. Patients not eligible for intervention or with chronic, subacute onset, colonic only, venous, or non-occlusive mesenteric ischaemia were excluded. Patients were divided into two groups according to the first speciality examining the patient (surgical emergency room [SER], surgeon examining the patient first or non-surgical emergency room [non-SER], internist examining the patient first). The primary endpoint was first door to operation time and secondary endpoints were length of stay and 90 day mortality. Results: Eighty-one patients with AMI were included. Fifty patients (62%) died during the first 30 days and 53 (65%) within 90 days. Presenting first in non-SER (vs. SER) was independently associated with a first door to operation time of over 12 h (OR 3.7 [95% CI 1.3-10.2], median time 15.2 h [IQR 10.9-21.2] vs. 10.1 h [IQR 6.9-18.5], respectively, p = .025). The length of stay was shorter (median 6.5 days [4.0-10.3] vs. 10.8 days [7.0-22.3], p = .045) and 90 day mortality was lower in the SER group (50.0% vs. 74.5%, p = .025). Conclusions: The first specialty that the patient encounters seems to be crucial for both delayed management and early survival of AMI. Developing fast/direct pathways to a unit with both gastrointestinal and vascular surgeons offers the possibility of improving the outcome of AMI. en
dc.format.extent 8
dc.language.iso eng
dc.relation.ispartof European Journal of Vascular and Endovascular Surgery
dc.rights en
dc.subject 3126 Surgery, anesthesiology, intensive care, radiology en
dc.subject DELAY en
dc.subject Embolus en
dc.subject Emergency en
dc.subject Revascularisation en
dc.subject THROMBOSIS en
dc.title Choice of First Emergency Room Affects the Fate of Patients With Acute Mesenteric lschaemia : The Importance of Referral Patterns and Triage en
dc.type Article
dc.description.version Peer reviewed
dc.description.version Non Peer reviewed
dc.identifier.doi https://doi.org/10.1016/j.ejvs.2019.01.002
dc.type.uri info:eu-repo/semantics/other
dc.type.uri info:eu-repo/semantics/publishedVersion
dc.type.uri http://purl.org/eprint/status/NonPeerReviewed
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