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Table 1 Definitions of indications for use of damage control content, construct, and criterion validity

From: Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review

Type of measurement validity Epidemiologic definition [21 22] Operationalized definition Theoretical example of study evaluating indication content, construct, or criterion validity
Content Extent to which the indication incorporates the domain of the phenomenon under study (e.g., the extent to which the indication includes clinical situations that surgeons feel may influence use of DC or that is associated with the choice to perform DC over definitive surgery) Extent to which surgeons reported that they would perform DC in a given clinical scenario or that an indication predicted use of DC in practice In a cross-sectional survey of surgeons, X% reported that they would perform DC when a major abdominal vascular injury was identified at laparotomy
In a cohort study, the intraoperative identification of a major abdominal vascular injury was associated with OR of X (95% CI, X-X) for performing DC instead of definitive surgery in practice
Construct Extent to which the indication corresponds to theoretical concepts (constructs) under study (e.g., if an indication has construct validity, it should be associated with poor patient outcomes when patients undergo definitive instead of DC surgery) How well one indication or a combination of indications and demographic variables predicted poor outcomes in patients not treated with DC (i.e., the extent to which an indication was associated with a higher probability of poor outcomes in patients treated with definitive surgery and therefore should be considered as a potential indication for DC) In a cohort study, the intraoperative identification of a major abdominal vascular injury was associated with an increased risk of mortality in patients who underwent definitive laparotomy for trauma
Criterion Extent to which the indication related to a reference standard (e.g., the extent to which conducting DC instead of definitive surgery in that clinical situation was associated with an improvement in outcomes) Extent to which the utilization or conduct of DC instead of definitive surgery for one or more indications was associated with improved patient outcomes In a cohort study, use of DC instead of definitive surgery for patients with a major abdominal vascular injury was associated with an improvement in in-hospital adjusted mortality
  1. Where CI indicates confidence interval; DC, damage control; and OR, odds ratio