Damage Control Indication for Severe Blunt Trauma Injuries in Japan

Abstract

The indication for damage control surgery (DCS) in severe trauma patients is still unclear. We sought for a new criterion for DCS focusing on blunt trauma injuries. We used the data from the Japan Trauma Data Bank (JTDB) and analyzed the 1,934 blunt trauma patients who were focused assessment with sonography in trauma (FAST) positive and underwent an emergency laparotomy. We compared the 364 patients that underwent DCS to the 1,570 patients who underwent a typical laparotomy. Patients who underwent DCS had worse vital signs upon arrival, higher blood transfusion rates, and higher mortality rates. Logistic regression analysis revealed blood pressure, consciousness, and body temperature as independent risk variables for DCS. From these variables, we created a DCS prediction score comprised of blood pressure, body temperature, and GCS. This score had a positive correlation with mortality, and with a cut-off value of three points, the score had a sensitivity of 68％ and specificity of 63％, and also with a mortality of 35.8％. This score could be a legitimate indicator for damage control surgery in Japan.