Derek J Roberts1,2, Niklas Bobrovitz3, David A Zygun4, Andrew W Kirkpatrick5,6,7, Chad G Ball5,7,8, Peter D Faris9, Henry T Stelfox6,10,11. 1. Division of Vascular and Endovascular Surgery, University of Ottawa, Ottawa, ON, Canada. Derek.Roberts01@gmail.com. 2. Clinical Epidemiology Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada. Derek.Roberts01@gmail.com. 3. Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. 4. Division of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada. 5. Department of Surgery, University of Calgary, Calgary, AB, Canada. 6. Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada. 7. The Regional Trauma Program, University of Calgary and the Foothills Medical Center, Calgary, AB, Canada. 8. Department of Oncology, University of Calgary and the Foothills Medical Centre, Calgary, AB, Canada. 9. Alberta Health Sciences Research-Research Analytics, University of Calgary and the Foothills Medical Centre, Calgary, AB, Canada. 10. O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada. 11. Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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.
BACKGROUND: Although damage control (DC) surgery is widely assumed to reduce mortalityincritically injuredpatients, 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 traumapatients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DCin that clinical scenario or the indication predicted use of DCin 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 traumapatients 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.
Authors: Derek J Roberts; David A Zygun; Peter D Faris; Chad G Ball; Andrew W Kirkpatrick; Henry T Stelfox Journal: J Am Coll Surg Date: 2016-06-16 Impact factor: 6.113
Authors: Todd W Rice; Stephen Morris; Bartholomew J Tortella; Arthur P Wheeler; Michael C Christensen Journal: Crit Care Med Date: 2012-03 Impact factor: 7.598
Authors: Andrew W Kirkpatrick; Kevin B Laupland; Shahzeer Karmali; Eric Bergeron; T Charyk Stewart; Christie Findlay; N Parry; Suneel Khetarpal; D Evans Journal: J Trauma Date: 2006-02
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Authors: Derek J Roberts; Peter D Faris; Chad G Ball; Andrew W Kirkpatrick; Ernest E Moore; David V Feliciano; Peter Rhee; Scott D'Amours; Henry T Stelfox Journal: World J Emerg Surg Date: 2021-10-14 Impact factor: 5.469