Roberts Derek J, Bobrovitz Niklas, Zygun David A, Ball Chad G, Kirkpatrick Andrew W, Faris Peter D, Brohi Karim, D'Amours Scott, Fabian Timothy C, Inaba Kenji, Leppäniemi Ari K, Moore Ernest E, Navsaria Pradeep H, Nicol Andrew J, Parry Neil, Stelfox Henry T
*Department of Surgery, University of Calgary, Calgary, Alberta, Canada †Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada ‡Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada §Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada ¶Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom ||Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada **Department of Oncology, University of Calgary, Calgary, Alberta, Canada ††Alberta Health Sciences Research-Research Analytics, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada ‡‡Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom §§Department of Surgery, University of New South Wales, Liverpool Hospital, Australia ¶¶Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN ||||Department of Surgery, University of Southern California, Los Angeles, CA ***Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland †††Department of Surgery, University of Colorado, Denver, CO ‡‡‡Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa §§§Divisions of General Surgery and Critical Care, Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, Western University and the Trauma Program, London Health Sciences Centre, London, Ontario, Canada ¶¶¶Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Ann Surg. 2016 May;263(5):1018-27. doi: 10.1097/SLA.0000000000001347.
To characterize and evaluate indications for use of damage control (DC) surgery in civilian trauma patients.
Although DC surgery may improve survival in select, severely injured patients, the procedure is associated with significant morbidity, suggesting that it should be used only when appropriately indicated.
Two investigators used an abbreviated grounded theory method to synthesize indications for DC surgery reported in peer-reviewed articles between 1983 and 2014 into a reduced number of named, content-characteristic codes representing unique indications. An international panel of trauma surgery experts (n = 9) then rated the appropriateness (expected benefit-to-harm ratio) of the coded indications for use in surgical practice.
The 1107 indications identified in the literature were synthesized into 123 unique pre- (n = 36) and intraoperative (n = 87) indications. The panel assessed 101 (82.1%) of these indications to be appropriate. The indications most commonly reported and assessed to be appropriate included pre- and intraoperative hypothermia (median temperature <34°C), acidosis (median pH <7.2), and/or coagulopathy. Others included 5 different injury patterns, inability to control bleeding by conventional methods, administration of a large volume of packed red blood cells (median >10 units), inability to close the abdominal wall without tension, development of abdominal compartment syndrome during attempted abdominal wall closure, and need to reassess extent of bowel viability.
This study identified a comprehensive list of candidate indications for use of DC surgery. These indications provide a practical foundation to guide surgical practice while studies are conducted to evaluate their impact on patient care and outcomes.
描述和评估损伤控制（DC）手术在 civilian 创伤患者中的使用指征。
尽管 DC 手术可能提高特定严重受伤患者的生存率，但该手术会带来显著的发病率，这表明仅在适当指征下才应使用。
两名研究者采用简化的扎根理论方法，将 1983 年至 2014 年间同行评审文章中报道的 DC 手术指征综合为数量减少的、代表独特指征的命名内容特征编码。然后，一个国际创伤外科专家小组（n = 9）对编码指征在手术实践中的使用适宜性（预期的利弊比）进行评分。
文献中确定的 1107 个指征被综合为 123 个独特的术前（n = 36）和术中（n = 87）指征。该小组评估这些指征中有 101 个（82.1%）是适宜的。最常报道且被评估为适宜的指征包括术前和术中体温过低（中位温度 <34°C）、酸中毒（中位 pH <7.2）和/或凝血功能障碍。其他指征包括 5 种不同的损伤模式、无法通过传统方法控制出血、输注大量浓缩红细胞（中位 >10 单位）、无法无张力关闭腹壁、在尝试关闭腹壁时出现腹腔间隔室综合征以及需要重新评估肠存活范围。
本研究确定了一份全面的 DC 手术候选指征清单。这些指征为指导手术实践提供了实用基础，同时开展研究以评估它们对患者护理和结局的影响。
