title: Indications for Use of Damage Control Surgery in Civilian Trauma Patients: A Content Analysis and Expert Appropriateness Rating Study.
abstract: OBJECTIVE
  To characterize and evaluate indications for use of damage control (DC) surgery in civilian trauma patients.
  
  
  BACKGROUND
  Although DC surgery may improve survival in select, severely injured patients, the procedure is associated with significant morbidity, suggesting that it should be used only when appropriately indicated.
  
  
  METHODS
  Two investigators used an abbreviated grounded theory method to synthesize indications for DC surgery reported in peer-reviewed articles between 1983 and 2014 into a reduced number of named, content-characteristic codes representing unique indications. An international panel of trauma surgery experts (n = 9) then rated the appropriateness (expected benefit-to-harm ratio) of the coded indications for use in surgical practice.
  
  
  RESULTS
  The 1107 indications identified in the literature were synthesized into 123 unique pre- (n = 36) and intraoperative (n = 87) indications. The panel assessed 101 (82.1%) of these indications to be appropriate. The indications most commonly reported and assessed to be appropriate included pre- and intraoperative hypothermia (median temperature <34°C), acidosis (median pH <7.2), and/or coagulopathy. Others included 5 different injury patterns, inability to control bleeding by conventional methods, administration of a large volume of packed red blood cells (median >10 units), inability to close the abdominal wall without tension, development of abdominal compartment syndrome during attempted abdominal wall closure, and need to reassess extent of bowel viability.
  
  
  CONCLUSIONS
  This study identified a comprehensive list of candidate indications for use of DC surgery. These indications provide a practical foundation to guide surgical practice while studies are conducted to evaluate their impact on patient care and outcomes.
authors.affiliation: *Department of Surgery, University of Calgary, Calgary, Alberta, Canada †Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada ‡Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada §Regional Trauma Program, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada ¶Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom ||Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada **Department of Oncology, University of Calgary, Calgary, Alberta, Canada ††Alberta Health Sciences Research-Research Analytics, University of Calgary and the Foothills Medical Centre, Calgary, Alberta, Canada ‡‡Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, United Kingdom §§Department of Surgery, University of New South Wales, Liverpool Hospital, Australia ¶¶Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN ||||Department of Surgery, University of Southern California, Los Angeles, CA ***Department of Surgery, Helsinki University Central Hospital, Helsinki, Finland †††Department of Surgery, University of Colorado, Denver, CO ‡‡‡Trauma Centre, Department of Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa §§§Divisions of General Surgery and Critical Care, Departments of Surgery and Medicine, Schulich School of Medicine and Dentistry, Western University and the Trauma Program, London Health Sciences Centre, London, Ontario, Canada ¶¶¶Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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: Karim
authors.initials: K
authors.lastname: Brohi
authors.forename: Scott
authors.initials: S
authors.lastname: D'Amours
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Ari K
authors.initials: AK
authors.lastname: Leppäniemi
authors.forename: Ernest E
authors.initials: EE
authors.lastname: Moore
authors.forename: Pradeep H
authors.initials: PH
authors.lastname: Navsaria
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Nicol
authors.forename: Neil
authors.initials: N
authors.lastname: Parry
authors.forename: Henry T
authors.initials: HT
authors.lastname: Stelfox
mesh_terms: D032921:Consensus; D003422:Critical Care / Q000379:methods*; D006801:Humans; D010347:Patient Care Planning; D013514:Surgical Procedures, Operative / Q000379:methods*; D014947:Wounds and Injuries / Q000601:surgery*