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05.10.2021 | Original Article

Status quo of the use of DCS concepts and outcome with focus on blunt abdominal trauma

A registry-based analysis from the TraumaRegister DGU®

verfasst von: Arnulf Willms, Christoph Güsgen, Robert Schwab, Rolf Lefering, Sebastian Schaaf, Johan Lock, Erwin Kollig, Christoph Jänig, Dan Bieler, the Committee on Emergency Medicine, Intensive Care, Trauma Management (Sektion N. I. S.) of the German Trauma Society (DGU)

Erschienen in: Langenbeck's Archives of Surgery | Ausgabe 2/2022

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Abstract

Introduction

Damage control surgery (DCS) is a standardized treatment concept in severe abdominal injury. Despite its evident advantages, DCS bears the risk of substantial morbidity and mortality, due to open abdomen therapy (OAT). Thus, identifying the suitable patients for that approach is of utmost importance. Furthermore, little is known about the use of DCS and the related outcome, especially in blunt abdominal trauma.

Methods

Patients recorded in the TraumaRegister DGU® from 2008 to 2017, and with an Injury Severity Score (ISS) ≥ 9 and an abdominal injury with an Abbreviated Injury Scale (AIS) score ≥ 3 were included in that registry-based analysis. Patients with DCS and temporary abdominal closure (TAC) were compared with patients who were treated with a laparotomy and primary closure (non-DCS) and those who did receive non-operative management (NOM). Following descriptive analysis, a matched-pairs study was conducted to evaluate differences and outcomes between DCS and non-DCS group. Matching criteria were age, abdominal trauma severity, and hemodynamical instability at the scene.

Results

The injury mechanism was predominantly blunt (87.1%). Of the 8226 patients included, 2351 received NOM, 5011 underwent laparotomy and primary abdominal closure (non-DCS), and 864 were managed with DCS. Thus, 785 patient pairs were analysed. The rate of hepatic injuries AIS > 3 differed between the groups (DCS 50.3% vs. non-DCS 18.1%). DCS patients had a higher ISS (p = 0.023), required more significant volumes of fluids, more catecholamines, and transfusions (p < 0.001). More DCS patients were in shock at the accident scene (p = 0.022). DCS patients had a higher number of severe hepatic (AIS score ≥ 3) and gastrointestinal injuries and more vascular injuries. Most severe abdominal injuries in non-DCS patients were splenic injuries (AIS, 4 and 5) (52.1% versus 37.9%, p = 0.004).

Conclusion

DCS is a strategy used in unstable trauma patients, severe hepatic, gastrointestinal, multiple abdominal injuries, and mass transfusions. The expected survival rates were achieved in such extreme trauma situations.

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Titel: Status quo of the use of DCS concepts and outcome with focus on blunt abdominal trauma
A registry-based analysis from the TraumaRegister DGU®
verfasst von: Arnulf Willms
Christoph Güsgen
Robert Schwab
Rolf Lefering
Sebastian Schaaf
Johan Lock
Erwin Kollig
Christoph Jänig
Dan Bieler
the Committee on Emergency Medicine, Intensive Care, Trauma Management (Sektion N. I. S.) of the German Trauma Society (DGU)
Publikationsdatum: 05.10.2021
Verlag: Springer Berlin Heidelberg
Erschienen in: Langenbeck's Archives of Surgery / Ausgabe 2/2022
Print ISSN: 1435-2443
Elektronische ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-021-02344-0

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Status quo of the use of DCS concepts and outcome with focus on blunt abdominal trauma

A registry-based analysis from the TraumaRegister DGU®