Roberts Derek J, Zygun David A, Kirkpatrick Andrew W, Ball Chad G, Faris Peter D, Bobrovitz Niklas, Robertson Helen Lee, Stelfox H Thomas
Department of Surgery, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada The Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada Department of Critical Care Medicine, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada.
Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
BMJ Open. 2014 Jul 7;4(7):e005634. doi: 10.1136/bmjopen-2014-005634.
Initial abbreviated surgery with planned reoperation (damage control surgery) is frequently used for major trauma patients to rapidly control haemorrhage while limiting surgical stress. Although damage control surgery may decrease mortality risk among the severely injured, it may also be associated with several complications when inappropriately applied. We seek to scope the literature on trauma damage control surgery, identify its proposed indications, map and clarify their definitions, and examine the content and evidence on which they are based. We also seek to generate a comprehensive list of unique indications to inform an appropriateness rating process.
We will search 11 electronic bibliographic databases, included article bibliographies and grey literature sources for citations involving civilian trauma patients that proposed one or more indications for damage control surgery or a damage control intervention. Indications will be classified into a predefined conceptual framework and categorised and described using qualitative content analysis. Constant comparative methodology will be used to create, modify and test codes describing principal findings or injuries (eg, bilobar liver injury) and associated decision variables (eg, coagulopathy) that comprise the reported indications. After a unique list of codes have been developed, we will use the organisational system recommended by the RAND/University of California, Los Angeles (RAND-UCLA) Appropriateness Rating Method to group principal findings or injuries into chapters (subdivided by associated decision variables) according to broader clinical findings encountered during surgical practice (eg, major liver injury).
This study will constitute the first step in a multistep research programme aimed at developing appropriate, evidence-informed indications for damage control in civilian trauma patients. With use of an integrated knowledge translation intervention that includes collaboration with surgical practice leaders, this research may allow for development of indications that are more likely to be relevant to and used by surgeons. Ethics approval is not required for this study.
初次进行简化手术并计划再次手术（损伤控制手术）常用于严重创伤患者，以迅速控制出血，同时限制手术应激。尽管损伤控制手术可能降低重伤患者的死亡风险，但不当应用时也可能引发多种并发症。我们旨在梳理创伤损伤控制手术的文献，确定其建议的适应证，梳理并阐明其定义，审视其依据的内容和证据。我们还旨在生成一份全面的独特适应证清单，为适宜性评级过程提供参考。
我们将检索11个电子文献数据库，包括文章参考文献和灰色文献来源，以查找涉及提出损伤控制手术或损伤控制干预一项或多项适应证的 civilian 创伤患者的引文。适应证将被分类到一个预先定义的概念框架中，并使用定性内容分析进行分类和描述。将采用持续比较法来创建、修改和测试描述主要发现或损伤（如双侧肝损伤）以及构成报告适应证的相关决策变量（如凝血障碍）的编码。在制定出一份独特的编码清单后，我们将使用由兰德公司/加利福尼亚大学洛杉矶分校（RAND-UCLA）适宜性评级方法推荐的组织系统，根据手术实践中遇到的更广泛临床发现（如严重肝损伤），将主要发现或损伤分组到各章节（按相关决策变量细分）。
本研究将构成一个多步骤研究项目的第一步，该项目旨在为 civilian 创伤患者的损伤控制制定合适的、基于证据的适应证。通过使用包括与外科手术实践领导者合作的综合知识转化干预措施，本研究可能有助于制定出更有可能与外科医生相关且被其采用的适应证。本研究无需伦理批准。
