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

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• 作者：Derek J. Roberts ; MD ; PhD^a ; ^b ; ^c ; ^f ; ^{Derek.Roberts01@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; David A. Zygun ; MD ; MSc^b ; ^h ; Peter D. Faris ; PhD^g ; Chad G. Ball ; MD ; MSc ; FACS^a ; ^d ; ^f ; Andrew W. Kirkpatrick ; MD ; MHSc ; FACS^a ; ^f ; Henry T. Stelfox ; MD ; PhD^b ; ^c ; ^e ; Indications for Trauma Damage Control Surgery International Study GroupKarim Brohi ; MD ; Scott D'Amours ; MD ; Timothy C. Fabian ; MD ; Kenji Inaba ; MD ; Ari K. Leppä ; niemi ; MD ; PhD ; Ernest E. Moore ; MD ; Pradeep H. Navsaria ; MBChB ; MMed (Surg) ; Andrew J. Nicol ; MBChB ; PhD ; Neil Parry ; MD
• 关键词：BP ; blood pressure ; DC ; damage control ; ED ; emergency department ; INR ; international normalized ratio ; PRBCs ; packed red blood cells ; PT ; prothrombin time ; PTT ; partial thromboplastin time ; SMA ; superior mesenteric artery
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：223
• 期：3
• 页码：515-529
• 全文大小：1370 K

文摘

Variation in use of damage control (DC) surgery across trauma centers may be partially driven by surgeon uncertainty as to when it is appropriately indicated. We sought to determine opinions of practicing surgeons on the appropriateness of published indications for trauma DC surgery.

Study Design

We asked 384 trauma centers in the United States, Canada, and Australasia to nominate 1 to 3 surgeons at their center to participate in a survey about DC surgery. We then asked nominated surgeons their opinions on the appropriateness (benefit-to-harm ratio) of 43 literature-derived indications for use of DC surgery in adult civilian trauma patients.

Results

In total, 232 (64.8%) trauma centers nominated 366 surgeons, of whom 201 (56.0%) responded. Respondents rated 15 (78.9%) preoperative and 23 (95.8%) intraoperative indications to be appropriate. Indications respondents agreed had the greatest expected benefit included a temperature <34°C, arterial pH <7.2, and laboratory-confirmed (international normalized ratio/prothrombin time and/or partial thromboplastin time >1.5 times normal) or clinically observed coagulopathy in the pre- or intraoperative setting; administration of >10 units of packed red blood cells; requirement for a resuscitative thoracotomy in the emergency department; and identification of a juxtahepatic venous injury or devascularized or destroyed pancreas, duodenum, or pancreaticoduodenal complex during operation. Ratings were consistent across subgroups of surgeons with different training, experience, and practice settings.

Conclusions

We identified 38 indications that practicing surgeons agreed appropriately justified the use of DC surgery. Until further studies become available, these indications constitute a consensus opinion that can be used to guide practice in the current era of changing trauma resuscitation practices.