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4th World Trauma Congress Article
Damage control or definitive repair? A retrospective review of abdominal trauma at a major trauma center in South Africa
  1. Ross Weale1,
  2. Victor Kong2,3,
  3. Johan Buitendag4,
  4. Abraham Ras4,
  5. Joanna Blodgett5,
  6. Grant Laing3,
  7. John Bruce3,
  8. Wanda Bekker3,
  9. Vassil Manchev3,
  10. Damian Clarke2,3
  1. 1Department of Surgery, North Western Deanery, Manchester, United Kingdom
  2. 2Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
  3. 3Department of Surgery, University of KwaZulu Natal, Durban, South Africa
  4. 4Department of Surgery, Stellenbosch University, Cape Town, South Africa
  5. 5Department of Epidemiology, University College London, London, United Kingdom
  1. Correspondence to Dr Victor Kong, Department of Surgery, University of the Witwatersrand, 29 Princess of Wales Terrace, Parktown, Johannesburg, 2193, South Africa; victorywkong{at}yahoo.com

Abstract

Background This study set out to review a large series of trauma laparotomies from a single center and to compare those requiring damage control surgery (DCS) with those who did not, and then to interrogate a number of anatomic and physiologic scoring systems to see which best predicted the need for DCS.

Methods All patients over the age of 15 years undergoing a laparotomy for trauma during the period from December 2012 to December 2017 were retrieved from the Hybrid Electronic Medical Registry (HEMR) at the Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa. They were divided into two cohorts, namely the DCS and non-DCS cohort, based on what was recorded in the operative note. These groups were then compared in terms of demographics and spectrum of injury, as well as clinical outcome. The following scores were worked out for each patient: Penetrating Abdominal Trauma Index (PATI), Injury Severity Score, Abbreviated Injury Scale-abdomen, and Abbreviated Injury Scale-chest.

Results A total of 562 patients were included, and 99 of these (18%) had a DCS procedure versus 463 (82%) non-DCS. The mechanism was penetrating trauma in 81% of cases (453 of 562). A large proportion of trauma victims were male (503 of 562, 90%), with a mean age of 29.5±10.8. An overall mortality rate of 32% was recorded for DCS versus 4% for non-DCS (p<0.001). In general patients requiring DCS had higher lactate, and were more acidotic, hypotensive, tachycardic, and tachypneic, with a lower base excess and lower bicarbonate, than patients not requiring DCS. The most significant organ injuries associated with DCS were liver and intra-abdominal vascular injury. The only organ injury consistently predictive across all models of the need for DCS was liver injury. Regression analysis showed that only the PATI score is significantly predictive of the need for DCS (p=0.044). A final multiple logistic regression model demonstrated a pH <7.2 to be the most predictive (p=0.001) of the need for DCS.

Conclusion DCS is indicated in a subset of severely injured trauma patients. A pH <7.2 is the best indicator of the need for DCS. Anatomic injuries in themselves are not predictive of the need for DCS.

Levels of evidence Level III.

  • trauma
  • critical care
  • laparotomy
  • damage control

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2018-000235

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    Footnotes

    • Contributors All authors contributed to the writing of the article, collection of data, and statistical analysis. The author order is reflective of the time of input each individual placed.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Ethics approval for the maintenance of the registry was provided by the Biomedical Research Ethics Committee (BREC) of the University of Kwa Zulu Natal (UKZN) (reference: BE207/09 and BCA 221/13).

    • Provenance and peer review Not commissioned; externally peer reviewed.