Damage control laparotomy in trauma: a pilot randomized controlled trial. The DCL trial

Area of Science:

• Trauma Surgery
• Surgical Critical Care
• Emergency Medicine

Background:

• Damage control laparotomy (DCL) is common for severe abdominal trauma but lacks randomized controlled trial (RCT) evidence.
• Surgeons often face equipoise regarding DCL versus definitive laparotomy (DEF).

Purpose of the Study:

• To pilot a randomized trial comparing DCL and DEF in severe abdominal trauma.
• To hypothesize that DEF reduces major abdominal complications (MAC) or 30-day mortality compared to DCL.

Main Methods:

• A pilot RCT randomized eligible emergency laparotomy patients to DCL or DEF.
• The primary outcome was MAC or death within 30 days.
• Frequentist and Bayesian analyses were employed.

Main Results:

• 39 patients were randomized (18 DCL, 21 DEF).
• The DEF group had higher Injury Severity Scores and received more blood products.
• Unadjusted analysis showed more MAC/death in the DEF group (33% vs 0% mortality, p=0.010).
• Adjusted analysis yielded a risk ratio of 1.54 (p=0.274) for MAC/death with DEF.
• Bayesian analysis suggested an 85% probability that DEF increased MAC/death (unadjusted).

Conclusions:

• Findings from this single-center pilot trial were inconclusive.
• DCL outcomes were not worse, and potentially better, than DEF.
• A larger, multicenter RCT of DCL versus DEF is feasible and warranted.