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BMC Surgery

, 14:24

Trauma care and orthopedic surgery

Abstract

BackgroundWe present a series of patients with blunt abdominal trauma who underwent damage control laparotomy DCL and introduce a nomogram that we created to predict survival among these patients.

MethodsThis was a retrospective study. From January 2002 to June 2012, 91 patients underwent DCL for hemorrhagic shock. We excluded patients with the following characteristics: a penetrating abdominal injury, age younger than 18 or older than 65 years, a severe or life-threatening brain injury Abbreviated Injury Scale AIS ≥ 4, emergency department ED arrival more than 6 hours after injury, pregnancy, end-stage renal disease, or cirrhosis. In addition, we excluded patients who underwent DCL after ICU admission or later in the course of hospitalization.

ResultsThe overall mortality rate was 61.5%: 35 patients survived and 56 died. We identified independent survival predictors, which included a preoperative Glasgow Coma Scale GCS score < 8 and a base excess BE value < -13.9 mEq-L. We created a nomogram for outcome prediction that included four variables: preoperative GCS, initial BE, preoperative diastolic pressure, and preoperative cardiopulmonary cerebral resuscitation CPCR.

ConclusionsDCL is a life-saving procedure performed in critical patients, and devastating clinical outcomes can be expected under such dire circumstances as blunt abdominal trauma with exsanguination. The nomogram presented here may provide ED physicians and trauma surgeons with a tool for early stratification and risk evaluation in critical, exsanguinating patients.

KeywordsBlunt abdominal trauma Damage control laparotomy Damage control surgery Electronic supplementary materialThe online version of this article doi:10.1186-1471-2482-14-24 contains supplementary material, which is available to authorized users.

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Author: Shang-Yu Wang - Chien-Hung Liao - Chih-Yuan Fu - Shih-Ching Kang - Chun-Hsiang Ouyang - I-Ming Kuo - Jr-Rung Lin - Yu-Pao 

Source: https://link.springer.com/article/10.1186/1471-2482-14-24







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