title: A protocol for a scoping and qualitative study to identify and evaluate indications for damage control surgery and damage control interventions in civilian trauma patients.
abstract: BACKGROUND
  Initial abbreviated surgery with planned reoperation (damage control surgery) is frequently used for major trauma patients to rapidly control haemorrhage while limiting surgical stress. Although damage control surgery may decrease mortality risk among the severely injured, it may also be associated with several complications when inappropriately applied. We seek to scope the literature on trauma damage control surgery, identify its proposed indications, map and clarify their definitions, and examine the content and evidence on which they are based. We also seek to generate a comprehensive list of unique indications to inform an appropriateness rating process.
  
  
  METHODS
  We will search 11 electronic bibliographic databases, included article bibliographies and grey literature sources for citations involving civilian trauma patients that proposed one or more indications for damage control surgery or a damage control intervention. Indications will be classified into a predefined conceptual framework and categorised and described using qualitative content analysis. Constant comparative methodology will be used to create, modify and test codes describing principal findings or injuries (eg, bilobar liver injury) and associated decision variables (eg, coagulopathy) that comprise the reported indications. After a unique list of codes have been developed, we will use the organisational system recommended by the RAND/University of California, Los Angeles (RAND-UCLA) Appropriateness Rating Method to group principal findings or injuries into chapters (subdivided by associated decision variables) according to broader clinical findings encountered during surgical practice (eg, major liver injury).
  
  
  BACKGROUND
  This study will constitute the first step in a multistep research programme aimed at developing appropriate, evidence-informed indications for damage control in civilian trauma patients. With use of an integrated knowledge translation intervention that includes collaboration with surgical practice leaders, this research may allow for development of indications that are more likely to be relevant to and used by surgeons. Ethics approval is not required for this study.
authors.affiliation: Department of Surgery, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada The Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada Department of Critical Care Medicine, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roberts
authors.affiliation: Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: David A
authors.initials: DA
authors.lastname: Zygun
authors.affiliation: Department of Surgery, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada The Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.affiliation: Department of Surgery, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada The Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada Department of Oncology, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: Alberta Health Sciences Research-Research Analytics, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Faris
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Niklas
authors.initials: N
authors.lastname: Bobrovitz
authors.affiliation: Health Sciences Library, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Helen Lee
authors.initials: HL
authors.lastname: Robertson
authors.affiliation: Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada Department of Critical Care Medicine, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada Department of Medicine, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada.
authors.forename: H Thomas
authors.initials: HT
authors.lastname: Stelfox
mesh_terms: D006801:Humans; D010347:Patient Care Planning; D036301:Qualitative Research; D012086:Reoperation; D012107:Research Design; D013514:Surgical Procedures, Operative / Q000379:methods*; D014947:Wounds and Injuries / Q000601:surgery*
keywords: TRAUMA MANAGEMENT