Damage control laparotomy for abdominal trauma in children.
BACKGROUND
Damage control laparotomy (DCL) is not well studied in the pediatric trauma population. The purpose of this study was to develop a surrogate definition of DCL compatible with national and administrative data sources so that the rate and outcomes of DCL in pediatric trauma patients could be determined.


METHODS
Using the 2010-2014 National Trauma Data Bank, children ≤18 with an abdominal AIS ≥ 3 who underwent a laparotomy within 3 h of arrival were identified (n = 2989). DCL was defined as occurring in children who underwent a second laparotomy within 5-48 h from the index laparotomy (n = 360). Children meeting these criteria were compared to those children who had the initial definitive operative management (n = 2174) and those who died prior to 48 h (n = 455).


RESULTS
DCL occurred in 12% of children with operative abdominal trauma. Children who underwent DCL had a greater median ISS (25 vs 18) and heart rate (112 vs 100), lower systolic blood pressure (104 vs 113), and GCS (12 vs 13), and were more likely to receive a preoperative blood transfusion (19 vs 11%) than those who had definitive initial operative management (all p < .05). Median length of stay (17 vs 8 days) and mortality (9 vs 2%) were greater following DCL than definitive initial operative management (p < .001). No differences in rate of DCL were seen based on ACS pediatric verification (p = .07).


CONCLUSIONS
Few children with operative abdominal trauma undergo DCL. DCL was associated with worse physiology rather than anatomic injury severity in this study. As expected, outcomes were worse following DCL.
Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, USA. habermann.elizabeth@mayo.edu.|Department of Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA. habermann.elizabeth@mayo.edu.
Stephanie F
SF
Polites
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
Elizabeth B
EB
Habermann
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA.
Amy E
AE
Glasgow
Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN, USA.
Martin D
MD
Zielinski
D000005:Abdomen / Q000601:surgery; D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D001794:Blood Pressure; D001803:Blood Transfusion; D005260:Female; D006339:Heart Rate; D006801:Humans; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
Damage control; Laparotomy; Pediatric trauma; Resuscitation