title: Evolution in damage control for exsanguinating penetrating abdominal injury.
abstract: OBJECTIVE
  Damage control (DC) has proven valuable in exsanguinated patients. The purpose of this study was to quantify and qualify the impact of current damage control principles applied in a penetrating abdominal injury (PAI) population.
  
  
  METHODS
  Over a 3-year period (June 1997-May 2000), of 271 laparotomies for PAI, 24 patients underwent DC (8.9%). Demographics, injury grade, resuscitative and operative parameters, acid-base status, coagulation profiles, fluid/transfusion requirements, definitive repairs, abdominal closure, complications, and outcomes were reviewed. Data were compared with our DC experience a decade earlier. Fisher's exact test was used for comparisons.
  
  
  RESULTS
  Overall survival improved for equivalent Injury Severity Score, Revised Trauma Score, TRISS, admission systolic blood pressure, operating room systolic blood pressure, and Penetrating Abdominal Trauma Index score. Solids (1.2 vs. 1.3), hollow organ (1.5 vs. 1.7), and major vascular injuries (0.5 vs. 0.8) per patient remain unchanged. Currently, there was less hypothermia with equivalent operating room times. In intensive care unit survivors, acid-base status was similar but coagulopathy and hypothermia were less severe. Definitive colon management has shifted from ostomies to anastomoses. Eventual fascial closure occurred in 14 of 19 (74%) compared with 12 of 14 (86%) in the historical group. There were three gastrointestinal fistulae (one pancreatic), one anastomotic leak, and three intra-abdominal abscesses.
  
  
  CONCLUSIONS
  Continued application of DC principles has led to improved survival with PAI. Better control of temperature, experience with the open abdomen, and intensive care unit care may be causative.
authors.affiliation: Department of Surgery, Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: J W
authors.initials: JW
authors.lastname: Johnson
authors.forename: V H
authors.initials: VH
authors.lastname: Gracias
authors.forename: C W
authors.initials: CW
authors.lastname: Schwab
authors.forename: P M
authors.initials: PM
authors.lastname: Reilly
authors.forename: D R
authors.initials: DR
authors.lastname: Kauder
authors.forename: M B
authors.initials: MB
authors.lastname: Shapiro
authors.forename: G P
authors.initials: GP
authors.lastname: Dabrowski
authors.forename: M F
authors.initials: MF
authors.lastname: Rotondo
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D003422:Critical Care; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012086:Reoperation; D012151:Resuscitation; D012771:Shock, Hemorrhagic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D015599:Trauma Severity Indices; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*