scholarly journals Indications for Use of Damage Control Surgery in Civilian Trauma Patients

2016 ◽  
Vol 263 (5) ◽  
pp. 1018-1027 ◽  
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

Indications for use of damage control surgery and damage control interventions in civilian trauma patients

2015 ◽  
Vol 78 (6) ◽  
pp. 1187-1196 ◽  
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

scholarly journals Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Derek J. Roberts ◽  
◽  
Niklas Bobrovitz ◽  
David A. Zygun ◽  
Andrew W. Kirkpatrick ◽  
...  
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) 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.

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

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.

Opinions of Practicing Surgeons on the Appropriateness of Published Indications for Use of Damage Control Surgery in Trauma Patients: An International Cross-Sectional Survey

2016 ◽  
Vol 223 (3) ◽  
pp. 515-529 ◽  
Author(s):  
Derek J. Roberts ◽  
David A. Zygun ◽  
Peter D. Faris ◽  
Chad G. Ball ◽  
Andrew W. Kirkpatrick ◽  
...  
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Indications For Use

scholarly journals 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 ◽  
2014 ◽  
Vol 4 (7) ◽  
pp. e005634-e005634 ◽  
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

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

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.

scholarly journals Resuscitation and coagulation in the severely injured trauma patient

2011 ◽  
Vol 366 (1562) ◽  
pp. 192-203 ◽  
Author(s):  
Mark J. Midwinter ◽  
Tom Woolley
Keyword(s):  
Trauma Patient ◽  
Damage Control ◽  
Damage Control Surgery ◽  
Physiological Status ◽  
Trauma Patients ◽  
Severely Injured ◽  
Mortality And Morbidity ◽  
Tissue Hypoperfusion ◽  
Coagulation Status ◽  
Haemostatic Resuscitation

Developments in the resuscitation of the severely injured trauma patient in the last decade have been through the increased understanding of the early pathophysiological consequences of injury together with some observations and experiences of recent casualties of conflict. In particular, the recognition of early derangements of haemostasis with hypocoagulopathy being associated with increased mortality and morbidity and the prime importance of tissue hypoperfusion as a central driver to this process in this population of patients has led to new resuscitation strategies. These strategies have focused on haemostatic resuscitation and the development of the ideas of damage control resuscitation and damage control surgery continuum. This in turn has led to a requirement to be able to more closely monitor the physiological status, of major trauma patients, including their coagulation status, and react in an anticipatory fashion.

Surgical Complications and Causes of Death in Trauma Patients that Require Temporary Abdominal Closure

2005 ◽  
Vol 71 (3) ◽  
pp. 219-224 ◽  
Author(s):  
JosÉ A. Montalvo ◽  
JosÉ A. Acosta ◽  
Pablo RodrÍguez ◽  
Kathia Alejandro ◽  
AndrÉs SÁrraga
Keyword(s):  
Surgical Complications ◽  
Causes Of Death ◽  
Surgical Complication ◽  
Damage Control ◽  
Multiple Logistic Regression Analysis ◽  
Hypovolemic Shock ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure

Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.

Coagulopathy, Hypothermia and Acidosis in Trauma Patients: the Rationale for Damage Control Surgery

2002 ◽  
Vol 102 (5) ◽  
pp. 313-316 ◽  
Author(s):  
J.J. De Waele ◽  
F.E.G. Vermassen
Keyword(s):  
Damage Control ◽  
Damage Control Surgery ◽  
Trauma Patients
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