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

World Journal of Emergency Surgery

Peter D. Faris¹  Henry T. Stelfox²  Andrew W. Kirkpatrick³  Chad G. Ball⁴  David A. Zygun⁵  Derek J. Roberts⁶  Niklas Bobrovitz⁷ 

[1] Alberta Health Sciences Research–Research Analytics, University of Calgary and the Foothills Medical Centre, Calgary, AB, Canada;Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada;O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada;Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada;Department of Surgery, University of Calgary, Calgary, AB, Canada;Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada;The Regional Trauma Program, University of Calgary and the Foothills Medical Center, Calgary, AB, Canada;Department of Surgery, University of Calgary, Calgary, AB, Canada;The Regional Trauma Program, University of Calgary and the Foothills Medical Center, Calgary, AB, Canada;Department of Oncology, University of Calgary and the Foothills Medical Centre, Calgary, AB, Canada;Division of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada;Division of Vascular and Endovascular Surgery, University of Ottawa, Ottawa, ON, Canada;Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;

关键词: Damage control;    Indications;    Major trauma;    Surgical procedures, operative;    Systematic review;   

DOI  :  10.1186/s13017-021-00352-5

来源: Springer

【 摘 要 】

BackgroundAlthough 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).MethodsWe 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.ResultsAmong 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.ConclusionsFew 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.

【 授权许可】

CC BY