Comparison of abdominal damage control surgery in combat versus civilian trauma

Chitra N. Sambasivan, Samantha J. Underwood, S. D. Cho, Laszlo N. Kiraly, Greg J. Hamilton, J. T. Kofoed, Stephen F. Flaherty, Warren C. Dorlac, Martin Schreiber

    Research output: Contribution to journalArticle

    10 Citations (Scopus)

    Abstract

    BACKGROUND: The majority of individuals who perform damage control surgery in the military arena are trained in civilian venues. Therefore, it is important to compare and contrast damage control performed in civilian and military settings. In contrast to civilian trauma, which is primarily caused by blunt injury and addressed at one or two surgical facilities, combat casualties primarily sustain explosion-related injuries and undergo treatment at multiple levels of care across continents. We aimed to compare patients undergoing abdominal damage control surgery across these two very different settings.

    METHODS: Parallel retrospective reviews were conducted over 2 years (2005-2006) in a combat setting and at a US Level I trauma center. Patients were examined during the first 7 days after injury.

    RESULTS: The civilian population (CP) was older (40 vs. 23; p <0.01) with a higher injury severity score (35 vs. 27; p <0.02). The CP experienced greater blunt injury than the military population (MP) (83 vs. 4%; p <0.01). Explosion-related injury was only present in the MP (64%). At baseline, the CP presented with lower systolic blood pressure (108 vs. 126) and larger base deficit (9.8 vs. 6.5; p <0.05). The MP underwent more surgeries (3.5 vs. 2.9; p = 0.02) with similar rates of fascial closure (48.7% vs. 70.0%; p = 0.11). Complication rates were similar between the CP and the MP (43% vs. 58%, respectively; p = 0.14).

    CONCLUSIONS: Military and civilian trauma patients who undergo damage control surgery experience similar fascial closure rates despite differing demographics and widely disparate mechanisms of injury. The MP undergoes a greater number of procedures than the CP, but complication rates do not differ between the groups.

    Original languageEnglish (US)
    Pages (from-to)S168-S174
    JournalThe Journal of trauma
    Volume69
    DOIs
    StatePublished - Jul 1 2010

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    Wounds and Injuries
    Population
    Nonpenetrating Wounds
    Explosions
    Blood Pressure
    Injury Severity Score
    Trauma Centers
    Demography

    ASJC Scopus subject areas

    • Medicine(all)

    Cite this

    Comparison of abdominal damage control surgery in combat versus civilian trauma. / Sambasivan, Chitra N.; Underwood, Samantha J.; Cho, S. D.; Kiraly, Laszlo N.; Hamilton, Greg J.; Kofoed, J. T.; Flaherty, Stephen F.; Dorlac, Warren C.; Schreiber, Martin.

    In: The Journal of trauma, Vol. 69, 01.07.2010, p. S168-S174.

    Research output: Contribution to journalArticle

    Sambasivan, CN, Underwood, SJ, Cho, SD, Kiraly, LN, Hamilton, GJ, Kofoed, JT, Flaherty, SF, Dorlac, WC & Schreiber, M 2010, 'Comparison of abdominal damage control surgery in combat versus civilian trauma', The Journal of trauma, vol. 69, pp. S168-S174. https://doi.org/10.1097/TA.0b013e3181e45cef
    Sambasivan, Chitra N. ; Underwood, Samantha J. ; Cho, S. D. ; Kiraly, Laszlo N. ; Hamilton, Greg J. ; Kofoed, J. T. ; Flaherty, Stephen F. ; Dorlac, Warren C. ; Schreiber, Martin. / Comparison of abdominal damage control surgery in combat versus civilian trauma. In: The Journal of trauma. 2010 ; Vol. 69. pp. S168-S174.
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    abstract = "BACKGROUND: The majority of individuals who perform damage control surgery in the military arena are trained in civilian venues. Therefore, it is important to compare and contrast damage control performed in civilian and military settings. In contrast to civilian trauma, which is primarily caused by blunt injury and addressed at one or two surgical facilities, combat casualties primarily sustain explosion-related injuries and undergo treatment at multiple levels of care across continents. We aimed to compare patients undergoing abdominal damage control surgery across these two very different settings.METHODS: Parallel retrospective reviews were conducted over 2 years (2005-2006) in a combat setting and at a US Level I trauma center. Patients were examined during the first 7 days after injury.RESULTS: The civilian population (CP) was older (40 vs. 23; p <0.01) with a higher injury severity score (35 vs. 27; p <0.02). The CP experienced greater blunt injury than the military population (MP) (83 vs. 4{\%}; p <0.01). Explosion-related injury was only present in the MP (64{\%}). At baseline, the CP presented with lower systolic blood pressure (108 vs. 126) and larger base deficit (9.8 vs. 6.5; p <0.05). The MP underwent more surgeries (3.5 vs. 2.9; p = 0.02) with similar rates of fascial closure (48.7{\%} vs. 70.0{\%}; p = 0.11). Complication rates were similar between the CP and the MP (43{\%} vs. 58{\%}, respectively; p = 0.14).CONCLUSIONS: Military and civilian trauma patients who undergo damage control surgery experience similar fascial closure rates despite differing demographics and widely disparate mechanisms of injury. The MP undergoes a greater number of procedures than the CP, but complication rates do not differ between the groups.",
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    T1 - Comparison of abdominal damage control surgery in combat versus civilian trauma

    AU - Sambasivan, Chitra N.

    AU - Underwood, Samantha J.

    AU - Cho, S. D.

    AU - Kiraly, Laszlo N.

    AU - Hamilton, Greg J.

    AU - Kofoed, J. T.

    AU - Flaherty, Stephen F.

    AU - Dorlac, Warren C.

    AU - Schreiber, Martin

    PY - 2010/7/1

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    N2 - BACKGROUND: The majority of individuals who perform damage control surgery in the military arena are trained in civilian venues. Therefore, it is important to compare and contrast damage control performed in civilian and military settings. In contrast to civilian trauma, which is primarily caused by blunt injury and addressed at one or two surgical facilities, combat casualties primarily sustain explosion-related injuries and undergo treatment at multiple levels of care across continents. We aimed to compare patients undergoing abdominal damage control surgery across these two very different settings.METHODS: Parallel retrospective reviews were conducted over 2 years (2005-2006) in a combat setting and at a US Level I trauma center. Patients were examined during the first 7 days after injury.RESULTS: The civilian population (CP) was older (40 vs. 23; p <0.01) with a higher injury severity score (35 vs. 27; p <0.02). The CP experienced greater blunt injury than the military population (MP) (83 vs. 4%; p <0.01). Explosion-related injury was only present in the MP (64%). At baseline, the CP presented with lower systolic blood pressure (108 vs. 126) and larger base deficit (9.8 vs. 6.5; p <0.05). The MP underwent more surgeries (3.5 vs. 2.9; p = 0.02) with similar rates of fascial closure (48.7% vs. 70.0%; p = 0.11). Complication rates were similar between the CP and the MP (43% vs. 58%, respectively; p = 0.14).CONCLUSIONS: Military and civilian trauma patients who undergo damage control surgery experience similar fascial closure rates despite differing demographics and widely disparate mechanisms of injury. The MP undergoes a greater number of procedures than the CP, but complication rates do not differ between the groups.

    AB - BACKGROUND: The majority of individuals who perform damage control surgery in the military arena are trained in civilian venues. Therefore, it is important to compare and contrast damage control performed in civilian and military settings. In contrast to civilian trauma, which is primarily caused by blunt injury and addressed at one or two surgical facilities, combat casualties primarily sustain explosion-related injuries and undergo treatment at multiple levels of care across continents. We aimed to compare patients undergoing abdominal damage control surgery across these two very different settings.METHODS: Parallel retrospective reviews were conducted over 2 years (2005-2006) in a combat setting and at a US Level I trauma center. Patients were examined during the first 7 days after injury.RESULTS: The civilian population (CP) was older (40 vs. 23; p <0.01) with a higher injury severity score (35 vs. 27; p <0.02). The CP experienced greater blunt injury than the military population (MP) (83 vs. 4%; p <0.01). Explosion-related injury was only present in the MP (64%). At baseline, the CP presented with lower systolic blood pressure (108 vs. 126) and larger base deficit (9.8 vs. 6.5; p <0.05). The MP underwent more surgeries (3.5 vs. 2.9; p = 0.02) with similar rates of fascial closure (48.7% vs. 70.0%; p = 0.11). Complication rates were similar between the CP and the MP (43% vs. 58%, respectively; p = 0.14).CONCLUSIONS: Military and civilian trauma patients who undergo damage control surgery experience similar fascial closure rates despite differing demographics and widely disparate mechanisms of injury. The MP undergoes a greater number of procedures than the CP, but complication rates do not differ between the groups.

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