Applications of Damage Control Surgery in Modern Civilian Trauma Care

Abstract Background Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes). Methods We searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications. Conclusions Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

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Comparison of Abdominal Damage Control Surgery in Combat Versus Civilian Trauma

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0b013e3181e45cef ◽

2010 ◽

Vol 69 (Supplement) ◽

pp. S168-S174 ◽

Cited By ~ 7

Author(s):

Chitra N. Sambasivan ◽

Samantha J. Underwood ◽

S. D. Cho ◽

Laszlo N. Kiraly ◽

Greg J. Hamilton ◽

...

Keyword(s):

Damage Control ◽

Damage Control Surgery ◽

Civilian Trauma

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Evidence for Use of Damage Control Surgery and Damage Control Interventions in Civilian Trauma Patients: A Systematic Review

10.21203/rs.3.rs-126134/v1 ◽

2020 ◽

Author(s):

Derek J. Roberts ◽

Niklas Bobrovitz ◽

David A. Zygun ◽

Andrew W. Kirkpatrick ◽

Chad G. Ball ◽

...

Keyword(s):

Systematic Review ◽

Damage Control ◽

Penetrating Trauma ◽

Damage Control Surgery ◽

Trauma Patients ◽

Clinical Scenario ◽

Cross Sectional ◽

Iliac Vessel ◽

Civilian Trauma ◽

Definitive Surgery

Abstract Background: Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes).Methods: We searched 11 databases (1950-April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Results: Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring >10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications.Conclusions: Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

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A protocol for a scoping and qualitative study to identify and evaluate indications for damage control surgery and damage control interventions in civilian trauma patients

BMJ Open ◽

10.1136/bmjopen-2014-005634 ◽

2014 ◽

Vol 4 (7) ◽

pp. e005634-e005634 ◽

Cited By ~ 11

Author(s):

D. J. Roberts ◽

D. A. Zygun ◽

A. W. Kirkpatrick ◽

C. G. Ball ◽

P. D. Faris ◽

...

Keyword(s):

Qualitative Study ◽

Damage Control ◽

Damage Control Surgery ◽

Trauma Patients ◽

Civilian Trauma

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Modern Trauma Care: Damage Control Surgery and Damage Control Resuscitation-Brief report

South Asian Journal of Emergency Medicine ◽

10.5455/sajem.030109 ◽

2020 ◽

pp. 1

Author(s):

Abdelkader Boukerrouche

Keyword(s):

Trauma Care ◽

Damage Control ◽

Damage Control Surgery ◽

Damage Control Resuscitation

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The Berlin Acute Trauma Care Instrument Set (BATMIN) – A Selected Combination of Surgical Instruments for Damage Control and Hemostasis Surgery in Severe Acute Trauma

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.288 ◽

2020 ◽

pp. 1-6

Author(s):

Sven Märdian ◽

Fitz Klein ◽

André Solarek ◽

Lena Nonnen ◽

Detlef Cwojdzinski ◽

...

Keyword(s):

Trauma Care ◽

Damage Control ◽

Damage Control Surgery ◽

Mass Casualty ◽

Surgical Instruments ◽

Mass Casualties ◽

Severely Injured ◽

Severely Injured Patients ◽

Acute Trauma ◽

Injured Patients

Abstract A lack of sterile surgical instrument sets for damage control surgeries of severely injured patients became evident in a series of in-hospital mass casualty trainings in the German capital of Berlin. Moreover, the existing instrument trays contained mostly specialized instruments for elective interventions and were not well composed for the treatment of poly-traumatized patients. After a literature search on the most common injury patterns in Mass Casualty Incidents (MCIs), an expert group of surgeons from different disciplines designed an optimized instrument set. A set of 194 instruments was assembled and distributed into two containers. These 2 sets were subjected to a 6-month trial phase in our hospital, and the evaluation of usability was subsequently analyzed through feedback forms administered to the staff. After analysis of the feedback sheets, only minor alterations had to be incorporated. The Berlin Acute Trauma Care Instrument Set (BATMIN) was then made available by the state of Berlin to Berlin Hospitals providing acute trauma care. Out of the need to be prepared for mass casualties, we created an instrument set suitable for the damage control surgery of severely injured patients in individual care and MCIs.

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Damage control – trauma care in the first hour and beyond: a clinical review of relevant developments in the field of trauma care

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609958253 ◽

2013 ◽

Vol 95 (3) ◽

pp. 177-183 ◽

Cited By ~ 18

Author(s):

AE Sharrock ◽

M Midwinter

Keyword(s):

Trauma Care ◽

Damage Control ◽

Damage Control Surgery ◽

Management Plan ◽

Ovid Medline ◽

Patient Will ◽

Trauma Networks ◽

Haemorrhage Control ◽

The Individual ◽

The Uk

Introduction Trauma provision in the UK is a topic of interest. Regional trauma networks and centres are evolving and research is blossoming, but what bearing does all this have on the care that is delivered to the individual patient? This article aims to provide an overview of key research concepts in the field of trauma care, to guide the clinician in decision making in the management of major trauma. Methods The Ovid MEDLINE®, EMBASE™ and PubMed databases were used to search for relevant articles on haemorrhage control, damage control resuscitation and its exceptions, massive transfusion protocols, prevention and correction of coagulopathy, acidosis and hypothermia, and damage-control surgery. Findings A wealth of research is available and a broad range has been reviewed to summarise significant developments in trauma care. Research has been categorised into disciplines and it is hoped that by considering each, a tailored management plan for the individual trauma patient will evolve, potentially improving patient outcome.

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Indications for Use of Damage Control Surgery in Civilian Trauma Patients

Annals of Surgery ◽

10.1097/sla.0000000000001347 ◽

2016 ◽

Vol 263 (5) ◽

pp. 1018-1027 ◽

Cited By ~ 44

Author(s):

Derek J. Roberts ◽

Niklas Bobrovitz ◽

David A. Zygun ◽

Chad G. Ball ◽

Andrew W. Kirkpatrick ◽

...

Keyword(s):

Damage Control ◽

Damage Control Surgery ◽

Trauma Patients ◽

Civilian Trauma ◽

Indications For Use

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Indications for the Appropriate Use of Damage Control Surgery and Damage Control Interventions in Civilian Trauma Patients

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v5i1.168 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Derek Jason Roberts ◽

Juan Duchesne ◽

Megan L. Brenner ◽

Bruno Pereira ◽

Bryan A. Cotton ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Damage Control ◽

Damage Control Surgery ◽

Healthcare Resource Utilization ◽

Trauma Patients ◽

Appropriate Use ◽

Initial Surgery ◽

Civilian Trauma ◽

Planned Reoperation

In patients undergoing emergent operation for trauma, surgeons must decide whether to perform a definitive or damage control (DC) procedure. DC surgery (abbreviated initial surgery followed by planned reoperation after a period of resuscitation in the intensive care unit) has been suggested to most benefit patients more likely to succumb from the “vicious cycle” of hypothermia, acidosis, and coagulopathy and/or postoperative abdominal compartment syndrome (ACS) than the failure to complete organ repairs. However, there currently exists no unbiased evidence to support that DC surgery benefits injured patients. Further, the procedure is associated with substantial morbidity, long lengths of intensive care unit and hospital stay, increased healthcare resource utilization, and possibly a reduced quality of life among survivors. Therefore, it is important to ensure that DC laparotomy is only utilized in situations where the expected procedural benefits are expected to outweigh the expected procedural harms. In this manuscript, we review the comparative effectiveness and safety of DC surgery when used for different procedural indications. We also review recent studies suggesting variation in use of DC surgery between trauma centers and the potential harms associated with overuse of the procedure. We also review published consensus indications for the appropriate use of DC surgery and specific abdominal, pelvic, and vascular DC interventions in civilian trauma patients. We conclude by providing recommendations as to how the above list of published appropriateness indications may be used to guide medical and surgical education, quality improvement, and surgical practice.

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