title: Management of the open abdomen during the global war on terror.
abstract: OBJECTIVE
  To evaluate factors that are predictive of delayed abdominal closure in patients injured during military conflict.
  
  
  METHODS
  Seventy-one patients managed with an open abdomen were identified from records at Landstuhl Regional Medical Center from 2005 and 2006. Follow-up data were available from Walter Reed Army Medical Center. Records were reviewed through all echelons of care. Ordinal logistic regression was used to predict delayed abdominal closure.
  
  
  RESULTS
  Patients sustained injury from blunt (n = 2), penetrating (n = 30), and blast (n = 39) mechanisms. The median Injury Severity Score was 25 (interquartile range, 17-34). Abdominal injury was observed in 85% of patients, and 48% underwent a massive transfusion. The median time to transfer to the United States was 5.3 days (interquartile range, 4.3-6.8 days). Abdomens were definitively closed downrange (11%), at Landstuhl Regional Medical Center (33%), or at Walter Reed Army Medical Center (56%). The median time until abdominal closure was 13 days (interquartile range, 4-40 days) in 2005 compared with 4 days (interquartile range, 1-14.5 days) in 2006 (P = .02). The multivariate model identified massive transfusion (odds ratio, 3.9), presence of complications (odds ratio, 5.1), and an injury date in 2005 (odds ratio, 3.4) as independently predictive variables for later abdominal closure.
  
  
  CONCLUSIONS
  Massive transfusion, occurrence of complications, and earlier injury date were predictive of delayed abdominal closure in casualties managed with an open abdomen. These data suggest an evolving approach to the management of severely injured combat casualties that involves earlier abdominal closure.
authors.affiliation: Department of Surgery, Division of Trauma, Critical Care, and Acute Care Surgery, Oregon Health & Science University, Portland, OR 97239-3098, USA. rihag@ohsu.edu
authors.forename: Gordon M
authors.initials: GM
authors.lastname: Riha
authors.forename: Laszlo N
authors.initials: LN
authors.lastname: Kiraly
authors.forename: Brian S
authors.initials: BS
authors.lastname: Diggs
authors.forename: S David
authors.initials: SD
authors.lastname: Cho
authors.forename: Loic J
authors.initials: LJ
authors.lastname: Fabricant
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Flaherty
authors.forename: Reed
authors.initials: R
authors.lastname: Kuehn
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Underwood
authors.forename: Martin A
authors.initials: MA
authors.lastname: Schreiber
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques; D000328:Adult; D001753:Blast Injuries / Q000601:surgery; D006801:Humans; D008889:Military Personnel; D015999:Multivariate Analysis; D023481:Terrorism; D013997:Time Factors; D014857:Warfare; D014945:Wound Healing; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery; D055815:Young Adult