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Damage control laparotomy for abdominal trauma in children.
Stephanie F Polites1,2, Elizabeth B Habermann3, Amy E Glasgow3
1Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, USA. habermann.elizabeth@mayo.edu.
Pediatric Surgery International
|February 8, 2017
Summary
Damage control laparotomy (DCL) in pediatric trauma is rare, affecting 12% of cases. This procedure is linked to poorer physiological status and worse patient outcomes, including increased mortality.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Surgical Outcomes
Background:
- Damage control laparotomy (DCL) is understudied in pediatric trauma.
- A surrogate definition is needed to assess DCL rates and outcomes in children.
Purpose of the Study:
- To develop a surrogate definition for DCL in pediatric trauma patients.
- To determine the incidence and outcomes of DCL using national data.
Main Methods:
- Utilized the 2010-2014 National Trauma Data Bank for children (≤18) with abdominal AIS ≥3.
- Defined DCL as a second laparotomy within 5-48 hours of the initial procedure.
- Compared DCL patients with those receiving definitive initial management and those deceased within 48 hours.
Main Results:
- DCL occurred in 12% of pediatric operative abdominal trauma cases.
- DCL patients exhibited worse physiological parameters (ISS, heart rate, blood pressure, GCS) and higher transfusion rates.
- DCL was associated with significantly longer hospital stays and higher mortality rates compared to definitive management.
Conclusions:
- Damage control laparotomy is infrequently performed in pediatric operative abdominal trauma.
- Worse patient physiology, not just injury severity, characterized DCL cases.
- Outcomes following DCL in children are demonstrably worse.
