Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review
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...
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doaj-6d4f7576c557449b9c61ae7864c6f6bf2021-03-14T12:14:41ZengBMCWorld Journal of Emergency Surgery1749-79222021-03-0116112310.1186/s13017-021-00352-5Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic reviewDerek J. Roberts0Niklas Bobrovitz1David A. Zygun2Andrew W. Kirkpatrick3Chad G. Ball4Peter D. Faris5Henry T. Stelfox6for the Indications for Trauma Damage Control Surgery International Study GroupDivision of Vascular and Endovascular Surgery, University of OttawaNuffield Department of Primary Care Health Sciences, University of OxfordDivision of Critical Care Medicine, University of AlbertaDepartment of Surgery, University of CalgaryDepartment of Surgery, University of CalgaryAlberta Health Sciences Research–Research Analytics, University of Calgary and the Foothills Medical CentreDepartment of Critical Care Medicine, University of Calgary and Alberta Health ServicesAbstract 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.https://doi.org/10.1186/s13017-021-00352-5Damage controlIndicationsMajor traumaSurgical procedures, operativeSystematic review |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Derek J. Roberts Niklas Bobrovitz David A. Zygun Andrew W. Kirkpatrick Chad G. Ball Peter D. Faris Henry T. Stelfox for the Indications for Trauma Damage Control Surgery International Study Group |
spellingShingle |
Derek J. Roberts Niklas Bobrovitz David A. Zygun Andrew W. Kirkpatrick Chad G. Ball Peter D. Faris Henry T. Stelfox for the Indications for Trauma Damage Control Surgery International Study Group Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review World Journal of Emergency Surgery Damage control Indications Major trauma Surgical procedures, operative Systematic review |
author_facet |
Derek J. Roberts Niklas Bobrovitz David A. Zygun Andrew W. Kirkpatrick Chad G. Ball Peter D. Faris Henry T. Stelfox for the Indications for Trauma Damage Control Surgery International Study Group |
author_sort |
Derek J. Roberts |
title |
Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review |
title_short |
Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review |
title_full |
Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review |
title_fullStr |
Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review |
title_full_unstemmed |
Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review |
title_sort |
evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review |
publisher |
BMC |
series |
World Journal of Emergency Surgery |
issn |
1749-7922 |
publishDate |
2021-03-01 |
description |
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. |
topic |
Damage control Indications Major trauma Surgical procedures, operative Systematic review |
url |
https://doi.org/10.1186/s13017-021-00352-5 |
work_keys_str_mv |
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