eprintid: 10127213 rev_number: 14 eprint_status: archive userid: 608 dir: disk0/10/12/72/13 datestamp: 2021-05-06 10:14:51 lastmod: 2021-10-29 22:59:29 status_changed: 2021-05-06 10:14:51 type: article metadata_visibility: show creators_name: Weale, R creators_name: Kong, V creators_name: Buitendag, J creators_name: Ras, A creators_name: Blodgett, J creators_name: Laing, G creators_name: Bruce, J creators_name: Bekker, W creators_name: Manchev, V creators_name: Clarke, D title: Damage control or definitive repair? A retrospective review of abdominal trauma at a major trauma center in South Africa. ispublished: pub divisions: UCL divisions: B02 divisions: C10 divisions: D16 divisions: G88 keywords: Critical care, damage control, laparotomy, trauma note: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. abstract: BACKGROUND: This study set out to review a large series of trauma laparotomies from a single center and to compare those requiring damage control surgery (DCS) with those who did not, and then to interrogate a number of anatomic and physiologic scoring systems to see which best predicted the need for DCS. METHODS: All patients over the age of 15 years undergoing a laparotomy for trauma during the period from December 2012 to December 2017 were retrieved from the Hybrid Electronic Medical Registry (HEMR) at the Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa. They were divided into two cohorts, namely the DCS and non-DCS cohort, based on what was recorded in the operative note. These groups were then compared in terms of demographics and spectrum of injury, as well as clinical outcome. The following scores were worked out for each patient: Penetrating Abdominal Trauma Index (PATI), Injury Severity Score, Abbreviated Injury Scale-abdomen, and Abbreviated Injury Scale-chest. RESULTS: A total of 562 patients were included, and 99 of these (18%) had a DCS procedure versus 463 (82%) non-DCS. The mechanism was penetrating trauma in 81% of cases (453 of 562). A large proportion of trauma victims were male (503 of 562, 90%), with a mean age of 29.5±10.8. An overall mortality rate of 32% was recorded for DCS versus 4% for non-DCS (p<0.001). In general patients requiring DCS had higher lactate, and were more acidotic, hypotensive, tachycardic, and tachypneic, with a lower base excess and lower bicarbonate, than patients not requiring DCS. The most significant organ injuries associated with DCS were liver and intra-abdominal vascular injury. The only organ injury consistently predictive across all models of the need for DCS was liver injury. Regression analysis showed that only the PATI score is significantly predictive of the need for DCS (p=0.044). A final multiple logistic regression model demonstrated a pH <7.2 to be the most predictive (p=0.001) of the need for DCS. CONCLUSIONS: DCS is indicated in a subset of severely injured trauma patients. A pH <7.2 is the best indicator of the need for DCS. Anatomic injuries in themselves are not predictive of the need for DCS. LEVELS OF EVIDENCE: Level III. date: 2019-01 date_type: published official_url: http://dx.doi.org/10.1136/tsaco-2018-000235 oa_status: green full_text_type: pub pmcid: PMC6560474 language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1831478 doi: 10.1136/tsaco-2018-000235 pii: tsaco-2018-000235 lyricists_name: Blodgett, Joanna lyricists_id: JBLOD00 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: Trauma Surgery & Acute Care Open volume: 4 number: 1 article_number: e000235 event_location: England citation: Weale, R; Kong, V; Buitendag, J; Ras, A; Blodgett, J; Laing, G; Bruce, J; ... Clarke, D; + view all <#> Weale, R; Kong, V; Buitendag, J; Ras, A; Blodgett, J; Laing, G; Bruce, J; Bekker, W; Manchev, V; Clarke, D; - view fewer <#> (2019) Damage control or definitive repair? A retrospective review of abdominal trauma at a major trauma center in South Africa. Trauma Surgery & Acute Care Open , 4 (1) , Article e000235. 10.1136/tsaco-2018-000235 <https://doi.org/10.1136/tsaco-2018-000235>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10127213/1/e000235.full.pdf