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. 2019 Apr 16;4(1):e000235.
doi: 10.1136/tsaco-2018-000235. eCollection 2019.

Damage control or definitive repair? A retrospective review of abdominal trauma at a major trauma center in South Africa

Ross Weale  1 , Victor Kong  2   3 , Johan Buitendag  4 , Abraham Ras  4 , Joanna Blodgett  5 , Grant Laing  3 , John Bruce  3 , Wanda Bekker  3 , Vassil Manchev  3 , Damian Clarke  2   3
Affiliations

Damage control or definitive repair? A retrospective review of abdominal trauma at a major trauma center in South Africa

Ross Weale et al. Trauma Surg Acute Care Open. .

Abstract

Background: This study set out to review a large series of trauma laparotomies from a single center and to compare those requiring damage control surgery (DCS) with those who did not, and then to interrogate a number of anatomic and physiologic scoring systems to see which best predicted the need for DCS.

Methods: All patients over the age of 15 years undergoing a laparotomy for trauma during the period from December 2012 to December 2017 were retrieved from the Hybrid Electronic Medical Registry (HEMR) at the Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa. They were divided into two cohorts, namely the DCS and non-DCS cohort, based on what was recorded in the operative note. These groups were then compared in terms of demographics and spectrum of injury, as well as clinical outcome. The following scores were worked out for each patient: Penetrating Abdominal Trauma Index (PATI), Injury Severity Score, Abbreviated Injury Scale-abdomen, and Abbreviated Injury Scale-chest.

Results: A total of 562 patients were included, and 99 of these (18%) had a DCS procedure versus 463 (82%) non-DCS. The mechanism was penetrating trauma in 81% of cases (453 of 562). A large proportion of trauma victims were male (503 of 562, 90%), with a mean age of 29.5±10.8. An overall mortality rate of 32% was recorded for DCS versus 4% for non-DCS (p<0.001). In general patients requiring DCS had higher lactate, and were more acidotic, hypotensive, tachycardic, and tachypneic, with a lower base excess and lower bicarbonate, than patients not requiring DCS. The most significant organ injuries associated with DCS were liver and intra-abdominal vascular injury. The only organ injury consistently predictive across all models of the need for DCS was liver injury. Regression analysis showed that only the PATI score is significantly predictive of the need for DCS (p=0.044). A final multiple logistic regression model demonstrated a pH <7.2 to be the most predictive (p=0.001) of the need for DCS.

Conclusion: DCS is indicated in a subset of severely injured trauma patients. A pH <7.2 is the best indicator of the need for DCS. Anatomic injuries in themselves are not predictive of the need for DCS.

Levels of evidence: Level III.

Keywords: critical care; damage control; laparotomy; trauma.

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Conflict of interest statement

Competing interests: None declared.

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References

    1. Rotondo MF, Schwab CW, McGonigal MD, Phillips GR, Fruchterman TM, Kauder DR, Latenser BA, Angood PA. 'Damage control': an approach for improved survival in Exsanguinating penetrating abdominal injury. J Trauma 1993;35:375–82. - PubMed
    1. Waibel BH, Rotondo MMF. Damage control surgery: it's evolution over the last 20 years. Rev Col Bras Cir 2012;39:314–21. 10.1590/S0100-69912012000400012 - DOI - PubMed
    1. Cirocchi R, Montedori A, Farinella E, Bonacini I, Tagliabue L, Abraha I, Cochrane Injuries Group . Damage control surgery for abdominal trauma. Cochrane Database Syst Rev 2013;35 - 10.1002/14651858.CD007438.pub3 - DOI - PMC - PubMed
    1. Roberts DJ, Bobrovitz N, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD, Brohi K, D'Amours S, Fabian TC, Inaba K, et al. . Indications for use of damage control surgery in civilian trauma patients: a content analysis and expert appropriateness rating study. Ann Surg 2016;263:1018–27. - 10.1097/SLA.0000000000001347 - DOI - PubMed
    1. Roberts DJ, Bobrovitz N, Zygun DA, Ball CG, Kirkpatrick AW, Faris PD, Parry N, Nicol AJ, Navsaria PH, Moore EE, et al. . Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: a content analysis and expert appropriateness rating study. J Trauma Acute Care Surg 2015;79:568–79. - 10.1097/TA.0000000000000821 - DOI - PubMed