title: Indications for use of thoracic, abdominal, pelvic, and vascular damage control interventions in trauma patients: A content analysis and expert appropriateness rating study.
abstract: BACKGROUND
  The use of abbreviated or damage control (DC) interventions may improve outcomes in severely injured patients when appropriately indicated. We sought to determine which indications for DC interventions have been most commonly reported in the peer-reviewed literature to date and evaluate the opinions of experts regarding the appropriateness (expected benefit-to-harm ratio) of the reported indications for use in practice.
  
  
  METHODS
  Two investigators used an abbreviated grounded theory method to synthesize indications for 16 different DC interventions reported in peer-reviewed articles between 1983 and 2014 into a reduced number of named, content-characteristic codes representing unique indications. For each indication code, an international panel of trauma surgery experts (n = 9) then rated the appropriateness of conducting the DC intervention of interest in an adult civilian trauma patient.
  
  
  RESULTS
  The 424 indications identified in the literature were synthesized into 101 unique indications. The panel assessed 12 (70.6%) of the coded indications for the 7 different thoracic, 47 (78.3%) for the 7 different abdominal/pelvic, and 18 (75.0%) for the 2 different vascular interventions to be appropriate for use in practice. These included indications for rapid lung-sparing surgery (pneumonorrhaphy, pulmonary tractotomy, and pulmonary wedge resection) (n = 1); pulmonary tractotomy (n = 3); rapid, simultaneously stapled pneumonectomy (n = 1); therapeutic mediastinal and/or pleural space packing (n = 4); temporary thoracic closure (n = 3); therapeutic perihepatic packing (n = 28); staged pancreaticoduodenectomy (n = 2); temporary abdominal closure (n = 12); extraperitoneal pelvic packing (n = 5); balloon catheter tamponade (n = 6); and temporary intravascular shunting (n = 11).
  
  
  CONCLUSIONS
  This study identified a list of candidate appropriate indications for use of 12 different DC interventions that were suggested by authors of peer-reviewed articles and assessed by a panel of independent experts to be appropriate. These indications may be used to focus future research and (in the interim) guide surgical practice while studies are conducted to evaluate their impact on patient outcomes.
authors.affiliation: From the Departments of Surgery (D.J.R., C.G.B., A.W.K.), Community Health Sciences (D.J.R., H.T.S.), Oncology (C.G.B.), Critical Care Medicine (H.T.S.), and Medicine (H.T.S.), the Regional Trauma Program (D.J.R., C.G.B., A.W.K.), and Alberta Health Sciences Research-Research Analytics (P.D.F.), University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada; Division of Critical Care Medicine (D.A.Z.), University of Alberta, Edmonton, Alberta, Canada; Division of General Surgery (N.P.), Department of Surgery, Division of Critical Care Medicine (N.P.), Department Medicine, Schulich School of Medicine and Dentistry, Western University, and the Trauma Program (N.P.), London Health Sciences Centre, London, Ontario, Canada; Nuffield Department of Primary Care Health Sciences (N.B.), University of Oxford, Oxford, United Kingdom; Centre for Trauma Sciences (K.B.), Blizard Institute, Queen Mary University of London, London, England, United Kingdom; Trauma Centre (A.J.N., P.H.N.), Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa; Department of Surgery (A.K.L.), Helsinki University Central Hospital, Helsinki, Finland; Department of Surgery (S.D.), University of New South Wales, Liverpool Hospital, Australia; Department of Surgery (E.E.M.), University of Colorado, Denver, Colorado; Department of Surgery (K.I.), University of Southern California, Los Angeles, California; and Department of Surgery (T.C.F.), University of Tennessee Health Science Center, Memphis, Tennessee.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Roberts
authors.forename: Niklas
authors.initials: N
authors.lastname: Bobrovitz
authors.forename: David A
authors.initials: DA
authors.lastname: Zygun
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Kirkpatrick
authors.forename: Peter D
authors.initials: PD
authors.lastname: Faris
authors.forename: Neil
authors.initials: N
authors.lastname: Parry
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Nicol
authors.forename: Pradeep H
authors.initials: PH
authors.lastname: Navsaria
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Ari K
authors.initials: AK
authors.lastname: Leppäniemi
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
authors.forename: Scott
authors.initials: S
authors.lastname: D'Amours
authors.forename: Karim
authors.initials: K
authors.lastname: Brohi
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery; D003422:Critical Care / Q000379:methods*; D006801:Humans; D010388:Pelvis / Q000293:injuries*; D013898:Thoracic Injuries / Q000601:surgery; D057772:Vascular System Injuries / Q000601:surgery; D014947:Wounds and Injuries / Q000601:surgery*