Journal of Emergencies, Trauma, and Shock
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Year : 2011  |  Volume : 4  |  Issue : 4  |  Page : 450-454

Damage control in severely injured trauma patients - A ten-year experience

1 Department of Surgery, Hospital Uster, Switzerland
2 Department of Surgery, Division of Trauma and Critical Care, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA
3 Department of Surgery, Division of Trauma Surgery, University Hospital Zurich, Switzerland

Correspondence Address:
Thomas Lustenberger
Department of Surgery, Division of Trauma and Critical Care, Los Angeles County + University of Southern California Medical Center, Los Angeles, CA
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-2700.86627

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Background : This study reviews our 10-year institutional experience with damage control management and investigates risk factors for early mortality. Materials and Methods : The trauma registry of our level I trauma centre was utilized to identify all patients from 01/96 through 12/05 who underwent initial damage control procedures. Demographics, clinical and physiological parameters, and outcomes were abstracted. Patients were categorized as either early survivors (surviving the first 72 hours after admission) or early deaths. Results : During the study period, 319 patients underwent damage control management. Overall, 52 patients (16.3%) died (early deaths) and 267 patients (83.7%) survived the first 72 hours (early survivors). Early deaths showed significantly deranged serum lactate (5.81±0.55 vs. 3.46±0.13 mmol/L; P<0.001), base deficit (10.10±0.95 vs. 4.90±0.28 mmol/L; P<0.001) and pH (7.16±0.03 vs. 7.29±0.01; P<0.001) levels compared to early survivors on hospital admission. An International Normalized Ratio >1.2, base deficit >3 mmol/L, head Abbreviated Injury Scale ≥3, body temperature <35°C, serum lactate >6 mmol/L, and hemoglobin <7 g/dL proved to be independent risk factors for early mortality on hospital admission. Conclusions : Several risk factors for early mortality such as severe head injury and the lethal triad (coagulopathy, acidosis and hypothermia) in patients undergoing damage control procedures were identified and should trigger the trauma surgeon to maintain aggressive resuscitation in the intensive care unit.

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