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Intra-Abdominal Hemorrhage Control: The Need for Routine Four-Quadrant Packing Explored.

Dominik A Jakob1, Panagiotis Liasidis1, Morgan Schellenberg1

  • 1Division of Trauma and Surgical Critical Care, Department of Surgery, Los Angeles County + University of Southern California Medical Center, University of Southern California, 2051 Marengo Street, Inpatient Tower (C), 5th Floor, C5L100, Los Angeles, CA, 90033, USA.

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This summary is machine-generated.

Routine four-quadrant packing (4QP) is often used in trauma laparotomy, but this study shows directed packing is sufficient for most patients. This approach saves time and reduces unnecessary injury in acute hemorrhage control.

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Area of Science:

  • Trauma Surgery
  • Surgical Hemorrhage Control
  • Emergency Medicine

Background:

  • Four-quadrant packing (4QP) is a standard initial approach for hemorrhage control in acute trauma laparotomy.
  • The clinical utility of 4QP in actively bleeding trauma patients requires further evaluation.

Purpose of the Study:

  • To assess the effectiveness of 4QP versus directed packing for intra-abdominal hemorrhage control in trauma laparotomy patients.
  • To determine the proportion of patients who would benefit from 4QP versus directed packing based on bleeding source.

Main Methods:

  • Retrospective analysis of adult trauma laparotomy patients with active intra-abdominal hemorrhage (01/2015-07/2019).
  • Hemorrhage sources categorized anatomically and by single (SBS) vs. multiple bleeding sites (MBS).
  • Effectiveness evaluated for liver/retrohepatic inferior vena cava (RIVC), spleen, and retroperitoneal zone 3 bleeding.

Main Results:

  • 148 patients had active hemorrhage; 47% SBS, 53% MBS.
  • Liver/RIVC was the most common bleeding source in both SBS and MBS groups.
  • Only 15% of patients met criteria for 4QP; 61% for directed packing; 24% for no packing.

Conclusions:

  • Routine 4QP is indicated in a small subset of trauma laparotomy patients.
  • Directed packing is effective, potentially faster, and reduces iatrogenic risks compared to routine 4QP.
  • Individualized packing strategies based on bleeding source are recommended.