A new look at criteria for damage control surgery

Area of Science:

• Trauma Surgery
• Surgical Critical Care
• Emergency Medicine

Background:

• Established criteria for damage control surgery (DCS) exist, but rapid assessment is crucial.
• Traditional coagulopathy tests are time-consuming, delaying life-saving interventions in critical trauma.
• Need for simplified, practical criteria for prompt DCS decision-making in severe injuries.

Purpose of the Study:

• To establish simplified and practical criteria for rapid decision-making regarding the need for DCS.
• To identify key indicators for predicting the necessity of damage control surgery.
• To improve patient outcomes through timely surgical intervention.

Main Methods:

• Retrospective analysis of 34 consecutive patients undergoing DCS for severe abdominal/pelvic injuries.
• Review of patient characteristics, clinical courses, laboratory data, and outcomes.
• Identification of predictive indicators for DCS success.

Main Results:

• Overall survival rate was 55.9%.
• Nonsurvivors had significantly lower initial systolic blood pressure (<90 mm Hg), lower base excess (<-7.5 mmol/L), and lower core temperature (<35.5°C).
• Patients meeting all three indicators had a significantly lower DCS success rate (28.6%) compared to those meeting fewer (75.0%).

Conclusions:

• Surgeons should consider DCS with one or two identified criteria, not waiting for all three.
• Proposed criteria may broaden DCS indications but prioritize saving lives in severe torso trauma.
• 'Over-triage' is acceptable with a clear decision-making protocol.