• Yutaka Umemura, Atsushi Watanabe, Takahiro Kinoshita, Natsuhiro Morita, Kazuma Yamakawa, and Satoshi Fujimi.
• From the Division of Trauma and Surgical Critical Care (Y.U., A.W., N.M., S.F.), Osaka General Medical Center, Osaka; Department of Traumatology and Acute Critical Medicine (T.K.), Graduate School of Medicine, Osaka University, Suita; and Department of Emergency Medicine (K.Y.), Osaka Medical College, Osaka, Japan.
• J Trauma Acute Care Surg. 2021 Feb 1; 90 (2): 232-239.

BackgroundThe hybrid emergency room (ER) system is a novel trauma workflow that uses angio-computed tomography equipment in a trauma resuscitation room. Although the hybrid ER system decreases time to start surgery and endovascular treatments and improves mortality, the optimal target benefitting from this system remained unclear. We aimed to identify a subset of trauma patients likely to receive the greatest benefits from the hybrid ER.MethodsThis retrospective cohort study was conducted in a tertiary hospital in Japan from August 2007 to January 2020. We consecutively included severe adult blunt trauma patients (Injury Severity Score [ISS], ≥16) and divided them into two groups: conventional group (August 2007 to July 2011) and hybrid ER (August 2011 to January 2020) group. We evaluated the association between the hybrid ER group and 28-day mortality using multivariable logistic regression analysis. The 28-day mortality trend during the study period was evaluated with restricted cubic spline analysis. To evaluate heterogeneity of effects within various patient severities, we evaluated whether the patients' ISS modified the effect of the hybrid ER on survival.ResultsAmong 1,050 trauma patients, the conventional group comprised 360 patients and the hybrid ER group comprised 690 patients. Injury Severity Score and probability of survival (Ps) were not significantly different between the groups. Twenty-eight-day mortality was significantly lower in the hybrid ER group (Ps-adjusted odds ratio, 0.48; 95% confidence interval, 0.32-0.71; p < 0.001). Restricted cubic spline analysis revealed that Ps-adjusted 28-day mortality sharply decreased approximately 200 days after installation of the hybrid ER. Increase of survival probabilities according to the increase of ISS was significantly improved in hybrid ER group (p = 0.014). Because ISS increased to >25, survival probabilities in the hybrid ER group were higher compared with those in the conventional group.ConclusionThe hybrid ER may improve posttraumatic mortality, especially in patients with higher baseline severity.Level Of EvidenceTherapeutic/care management, level IV.Copyright © 2020 American Association for the Surgery of Trauma.

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