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- Title
An outcome prediction model for exsanguinating patients with blunt abdominal trauma after damage control laparotomy: a retrospective study.
- Authors
Shang-Yu Wang; Chien-Hung Liao; Chih-Yuan Fu; Shih-Ching Kang; Chun-Hsiang Ouyang; I-Ming Kuo; Jr-Rung Lin; Yu-Pao Hsu; Chun-Nan Yeh; Shao-Wei Chen
- Abstract
Background We present a series of patients with blunt abdominal trauma who underwent damage control laparotomy (DCL) and introduce a nomogram that we created to predict survival among these patients. Methods This was a retrospective study. From January 2002 to June 2012, 91 patients underwent DCL for hemorrhagic shock. We excluded patients with the following characteristics: a penetrating abdominal injury, age younger than 18 or older than 65 years, a severe or life-threatening brain injury (Abbreviated Injury Scale [AIS] ≥ 4), emergency department (ED) arrival more than 6 hours after injury, pregnancy, end-stage renal disease, or cirrhosis. In addition, we excluded patients who underwent DCL after ICU admission or later in the course of hospitalization. Results The overall mortality rate was 61.5%: 35 patients survived and 56 died. We identified independent survival predictors, which included a preoperative Glasgow Coma Scale (GCS) score < 8 and a base excess (BE) value < −13.9 mEq/L. We created a nomogram for outcome prediction that included four variables: preoperative GCS, initial BE, preoperative diastolic pressure, and preoperative cardiopulmonary cerebral resuscitation (CPCR). Conclusions DCL is a life-saving procedure performed in critical patients, and devastating clinical outcomes can be expected under such dire circumstances as blunt abdominal trauma with exsanguination. The nomogram presented here may provide ED physicians and trauma surgeons with a tool for early stratification and risk evaluation in critical, exsanguinating patients.
- Subjects
ABDOMINAL surgery; ABDOMINAL diseases; HEMORRHAGIC shock; GLASGOW Coma Scale; BRAIN resuscitation; NOMOGRAPHY (Mathematics)
- Publication
BMC Surgery, 2014, Vol 14, Issue 1, p1
- ISSN
1471-2482
- Publication type
Article
- DOI
10.1186/1471-2482-14-24