Related Experiment Video
Updated: Mar 7, 2026
A Saline/Bipolar Radiofrequency Energy Device As an Adjunct for Hemostasis in Solid Organ Injury/Trauma
Published on: July 28, 2020
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.
Insights
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.
Background:
Damage control laparotomy (DCL) is not well studied in the pediatric trauma population. The purpose of this study was to develop a surrogate definition of DCL compatible with national and administrative data sources so that the rate and outcomes of DCL in pediatric trauma patients could be determined.
Methods:
Using the 2010-2014 National Trauma Data Bank, children ≤18 with an abdominal AIS ≥ 3 who underwent a laparotomy within 3 h of arrival were identified (n = 2989). DCL was defined as occurring in children who underwent a second laparotomy within 5-48 h from the index laparotomy (n = 360). Children meeting these criteria were compared to those children who had the initial definitive operative management (n = 2174) and those who died prior to 48 h (n = 455).
Results:
DCL occurred in 12% of children with operative abdominal trauma. Children who underwent DCL had a greater median ISS (25 vs 18) and heart rate (112 vs 100), lower systolic blood pressure (104 vs 113), and GCS (12 vs 13), and were more likely to receive a preoperative blood transfusion (19 vs 11%) than those who had definitive initial operative management (all p < .05). Median length of stay (17 vs 8 days) and mortality (9 vs 2%) were greater following DCL than definitive initial operative management (p < .001). No differences in rate of DCL were seen based on ACS pediatric verification (p = .07).
Conclusions:
Few children with operative abdominal trauma undergo DCL. DCL was associated with worse physiology rather than anatomic injury severity in this study. As expected, outcomes were worse following DCL.
