Indications for Use of Damage Control Surgery in Civilian Trauma Patients: A Content Analysis and Expert Appropriateness Rating Study. Issue 5 (May 2016)

• Record Type: Journal Article
• Authors: Roberts, Derek J.; Bobrovitz, Niklas; Zygun, David A.; Ball, Chad G.; Kirkpatrick, Andrew W.; Faris, Peter D.; Brohi, Karim; D'Amours, Scott; Fabian, Timothy C.; Inaba, Kenji; Leppäniemi, Ari K.; Moore, Ernest E.; Navsaria, Pradeep H.; Nicol, Andrew J.; Parry, Neil; Stelfox, Henry T.
• Is Part Of: Annals of surgery. Volume 263:Issue 5(2016:May)
• Publication Date: 2016-05
• Subjects: content analysis -- damage control surgery -- expert appropriateness rating study -- indications -- wounds and injuries; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000001347
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objectives: To characterize and evaluate indications for use of damage control (DC) surgery in civilian trauma patients. Background: 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. Methods: 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. Results: 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. Conclusions: 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. Abstract : Supplemental Digital Content is available in the text