Table 3 Content validity (surgeons would performed damage control in that clinical scenario or the indication predicts use of damage control in practice) of reported indications for use of damage control surgery or damage control interventions in civilian trauma patients

Prep for a second look [69]

NA

Percentage of respondents who would leave the abdomen open

6%

Abdominal organ distention [69]

22%

Inability to close the fascia [69]

20%

Physically unable to close the fascia [70]

NA

Percentage of respondents supporting relevance of indications for leaving the abdomen open after trauma laparotomy

87%

Planned reoperation [70]

80%

Intra-abdominal packing [70]

59%

Magnitude of injury/gestalt [70]

43%

Airway pressure measurements [70]

41%

Bladder pressure measurements [70]

39%

Visual edema of the bowel [70]

33%

Young previously healthy male; grade IV spleen injury identified at laparotomy; massive hemoperitoneum (20% blood volume loss); no other intra- or extra-abdominal injuries; 45 min laparotomy; given 4 L crystalloid and 4 U PRBCs; intraoperative temperature 36.2 °C, pH 7.34; INR 1.3; and [71]

NA

Percentage of respondents who would perform TAC^a

 Fascial closure possible without excessive tension

1%

 Fascial closure extremely tight

45%

 Fascial closure physically not possible but skin closure is

51%

 Neither fascial nor skin closure is possible

73%

Same as the above scenario except a splenectomy was performed; intraoperative temperature 34 °C, pH 7.16, and INR 2.0; and [71]

 Fascial closure possible without excessive tension

9%

 Fascial closure extremely tight

61%

 Fascial closure physically not possible but skin closure is

50%

 Neither fascial nor skin closure is possible

75%

Young previously healthy male; presented with severe hemorrhagic shock (40% blood volume loss); bleeding grade III stellate liver rupture with devitalization of 30% of the right hepatic lobe, grade IV spleen injury which is no longer bleeding, 6 cm diaphragmatic tear, devascularization of a 6 cm segment of small bowel, and a one-third thickness circumferential tear of the distal descending colon; after packing of liver and spleen and repair of the diaphragm, major bleeding appears controlled, but there is diffuse oozing from cut surfaces; BP is 80/40 mmHg with vasopressors and after infusion of 8 L of crystalloid and 16 U PRBCs; intraoperative temperature 34 °C, pH 7.16, and INR 2.0; and fascial closure without tension is possible [71]

75%

Subjectively tight closure [72]

NA

Percentage of respondents who were much less or less willing to close the abdomen after trauma laparotomy

77%

Massive bowel edema [72]

89%

Multiple intra-abdominal injuries [72]

21%

Intra-abdominal packing [72]

71%

Fecal contamination/peritonitis [72]

12%

Massive transfusion [72]

19%

Hypothermia [72]

21%

Acidosis (pH < 7.3) [72]

22%

Coagulopathy [72]

31%

Planned reoperation [72]

76%

Pulmonary deterioration on closure [72]

94%

Hemodynamic instability with closure [72]

91%

High ISS [15]

Study site, penetrating mechanism, major abdominal vascular injury

Use of DCL

OR per ISS ↑, 1.05 (95% CI, 1.02–1.07)

Systolic BP < 90 mmHg on admission and grade III–V liver injury [46]

None

Use of DCL

Not associated with use of DCL

An artificial neural network including variables for bullet wound location (right or left chest or upper or lower abdominal quadrant) and trajectory pattern [horizontal shift (e.g., one that traversed the abdomen from RUQ to LUQ) or entry wound in back] and lowest ED systolic BP predicted that DC laparotomy would be used in patients with a horizontal shift upper abdominal trajectory pattern and a systolic BP < 105 mmHg or a RUQ wound with a bullet retained in the same quadrant and a systolic BP < 90 mmHg [55]

Bullet wound location and trajectory pattern, lowest ED systolic BP

Use of DCL

Model Se, 83%; model Sp, 93%

Major abdominal vascular injury [15]

Study site, ISS, penetrating mechanism

Use of DCL

OR, 2.70 (95% CI, 1.42-5.16)

Combined AAST grade III–V liver and IV–V spleen injury [46]

None

Use of DCL

All patients with this injury pattern underwent DCL while 42% of those without it did not (p = 0.02)

AAST grade V liver injury [46]

NR

Use of DCL

Not associated with ↑ use of DCL when compared to patients with grade III-IV injury

Multiple trauma and AAST grade III-V liver injury [46]

NR

Use of DCL

Not associated with use of DCL

Transfusion > 10 U PRBCs and AAST grade III-V liver injury [46]

NR

Use of DCL

Not associated with use of DCL

Transfusion of a large volume of PRBCs [41]

FFP and fluids administered, BD, lactate

Use of DCL

OR per PRBC U ↑, 1.05 (95% CI, 0.85–1.29)

Transfusion of a large volume of FFP [41]

PRBCs and fluids administered, BD, lactate

Use of DCL

OR per FFP U ↑, 0.95 (95% CI, 0.77–1.18)

Administration of a large volume of fluids [41]

PRBCs and FFP administered, BD, lactate

Use of DCL

OR per L of fluids ↑, 1.13 (95% CI, 0.92–1.37)

A PRBC transfusion volume that exceeds the CAT [39]

Admission systolic BP, MOI, NISS

Use of DCL

HR, 2.72 (95% CI, 1.26–5.91)

The number of times the PRBC transfusion volume exceeds the CAT [39]

Admission systolic BP, MOI, NISS

Use of DCL

HR per CAT multiple, 1.27 (95% CI, 1.11–1.47) (survival was 89.3%, 66.7%, 64.3%, and 75% in CAT0, CAT1, CAT2, and CAT3 pts, respectively )[39]

Elevated BD (max BD) [41]

PRBCs, FFP, and fluids transfused, lactate

Use of DCL

OR per max BD ↑, 1.25 (95% CI, 0.97–1.61)

Elevated lactate (max lactate) [41]

PRBCs, FFP, and fluids transfused, BD

Use of DCL

OR per max lactate ↑, 0.94 (95% CI, 0.73–1.22)