Indications for Use of Damage Control Surgery in Civilian Trauma Patients
To characterize and evaluate indications for use of damage control (DC) surgery in civilian trauma patients.
Although DC surgery may improve survival in select, severely injured patients, the procedure is associated with significant morbidity, suggesting that it should be used only when appropriately indicated.
Two investigators used an abbreviated grounded theory method to synthesize indications for DC surgery reported in peer-reviewed articles between 1983 and 2014 into a reduced number of named, content-characteristic codes representing unique indications. An international panel of trauma surgery experts (n = 9) then rated the appropriateness (expected benefit-to-harm ratio) of the coded indications for use in surgical practice.
The 1107 indications identified in the literature were synthesized into 123 unique pre- (n = 36) and intraoperative (n = 87) indications. The panel assessed 101 (82.1%) of these indications to be appropriate. The indications most commonly reported and assessed to be appropriate included pre- and intraoperative hypothermia (median temperature <34°C), acidosis (median pH <7.2), and/or coagulopathy. Others included 5 different injury patterns, inability to control bleeding by conventional methods, administration of a large volume of packed red blood cells (median >10 units), inability to close the abdominal wall without tension, development of abdominal compartment syndrome during attempted abdominal wall closure, and need to reassess extent of bowel viability.
This study identified a comprehensive list of candidate indications for use of DC surgery. These indications provide a practical foundation to guide surgical practice while studies are conducted to evaluate their impact on patient care and outcomes.
Keywords: content analysis; damage control surgery; expert appropriateness rating study; indications; wounds and injuries
Document Type: Research Article
Affiliations: 1: Department of Surgery, University of Calgary, Calgary, Alberta, Canada, Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada, Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada, Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada 2: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom 3: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada, Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada 4: Department of Surgery, University of Calgary, Calgary, Alberta, Canada, Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada, Department of Oncology, University of Calgary, Calgary, Alberta, Canada 5: Department of Surgery, University of Calgary, Calgary, Alberta, Canada, Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada 6: Alberta Health Sciences Research–Research Analytics, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada 7: Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom 8: Department of Surgery, University of New South Wales, Liverpool Hospital, Australia 9: Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN 10: Department of Surgery, University of Southern California, Los Angeles, CA 11: Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland 12: Department of Surgery, University of Colorado, Denver, CO 13: Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa 14: Divisions of General Surgery and Critical Care, Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, Western University and the Trauma Program, London Health Sciences Centre, London, Ontario, Canada 15: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada, Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Publication date: 01 May 2016
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