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An outcome prediction model for exsanguinating patients with blunt abdominal trauma after damage control laparotomy:
Shang-Yu Wang, Chien-Hung Liao, Chih-Yuan Fu
1Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei Shan Township, Taoyuan, Taiwan. shangyu100@yahoo.com.tw.
Insights
This study introduces a nomogram to predict survival in patients with blunt abdominal trauma undergoing damage control laparotomy (DCL). Key predictors include Glasgow Coma Scale and base excess, aiding early risk evaluation for critical trauma patients.
Area of Science:
- Trauma Surgery
- Surgical Oncology
- Critical Care Medicine
Background:
- Blunt abdominal trauma frequently necessitates damage control laparotomy (DCL) in critically injured patients.
- Hemorrhagic shock is a common and life-threatening complication following blunt abdominal trauma.
- Predicting survival in patients undergoing DCL remains challenging due to the complexity of trauma and shock.
Purpose of the Study:
- To develop and validate a nomogram for predicting survival in patients with blunt abdominal trauma who undergo DCL.
- To identify independent predictors of survival in this patient population.
- To provide a clinical tool for early risk stratification and outcome prediction.
Main Methods:
- A retrospective study of 91 patients who underwent DCL for hemorrhagic shock between January 2002 and June 2012.
- Exclusion criteria included penetrating trauma, age extremes, severe brain injury (AIS ≥ 4), delayed presentation (>6 hours), pregnancy, and pre-existing conditions like ESRD or cirrhosis.
- Data collected included preoperative Glasgow Coma Scale (GCS), base excess (BE), diastolic pressure, and cardiopulmonary cerebral resuscitation (CPCR) status.
Main Results:
- The overall mortality rate was 61.5% (56 deaths out of 91 patients).
- Independent predictors of survival identified were a preoperative Glasgow Coma Scale (GCS) score < 8 and a base excess (BE) value < -13.9 mEq/L.
- A nomogram was constructed incorporating preoperative GCS, initial BE, preoperative diastolic pressure, and preoperative CPCR.
Conclusions:
- Damage control laparotomy (DCL) is a critical, life-saving intervention for severe blunt abdominal trauma with exsanguination.
- The developed nomogram offers a valuable tool for emergency department physicians and trauma surgeons to stratify risk and evaluate outcomes in critically injured patients.
- Early identification of high-risk patients through this nomogram can potentially guide management decisions and improve patient outcomes.
Background:
We present a series of patients with blunt abdominal trauma who underwent damage control laparotomy (DCL) and introduce a nomogram that we created to predict survival among these patients.
Methods:
This was a retrospective study. From January 2002 to June 2012, 91 patients underwent DCL for hemorrhagic shock. We excluded patients with the following characteristics: a penetrating abdominal injury, age younger than 18 or older than 65 years, a severe or life-threatening brain injury (Abbreviated Injury Scale [AIS] ≥ 4), emergency department (ED) arrival more than 6 hours after injury, pregnancy, end-stage renal disease, or cirrhosis. In addition, we excluded patients who underwent DCL after ICU admission or later in the course of hospitalization.
Results:
The overall mortality rate was 61.5%: 35 patients survived and 56 died. We identified independent survival predictors, which included a preoperative Glasgow Coma Scale (GCS) score < 8 and a base excess (BE) value < -13.9 mEq/L. We created a nomogram for outcome prediction that included four variables: preoperative GCS, initial BE, preoperative diastolic pressure, and preoperative cardiopulmonary cerebral resuscitation (CPCR).
Conclusions:
DCL is a life-saving procedure performed in critical patients, and devastating clinical outcomes can be expected under such dire circumstances as blunt abdominal trauma with exsanguination. The nomogram presented here may provide ED physicians and trauma surgeons with a tool for early stratification and risk evaluation in critical, exsanguinating patients.
