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European Journal of Trauma and Emergency Surgery

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Open Access 26-02-2022 | Central Nervous System Trauma | Original Article

Physiology dictated treatment after severe trauma: timing is everything

Authors: Karlijn J. P. van Wessem, Luke P. H. Leenen, Falco Hietbrink

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2022

Abstract

Introduction

Damage control strategies in resuscitation and (fracture) surgery have become standard of care in the treatment of severely injured patients. It is suggested that damage control improves survival and decreases the incidence of organ failure. However, these strategies can possibly increase the risk of complications such as infections. Indication for damage control procedures is guided by physiological parameters, type of injury, and the surgeon’s experience. We analyzed outcomes of severely injured patients who underwent emergency surgery.

Methods

Severely injured patients, admitted to a level-1 trauma center ICU from 2016 to 2020 who were in need of ventilator support and required immediate surgical intervention ( ≤24 h) were included. Demographics, treatment, and outcome parameters were analyzed.

Results

Hundred ninety-five patients were identified with a median ISS of 33 (IQR 25–38). Ninety-seven patients underwent immediate definitive surgery (ETC group), while 98 patients were first treated according to damage control principles with abbreviated surgery (DCS group). Although ISS was similar in both groups, DCS patients were younger, suffered from more severe truncal injuries, were more frequently in shock with more severe acidosis and coagulopathy, and received more blood products. ETC patients with traumatic brain injury needed more often a craniotomy. Seventy-four percent of DCS patients received definitive surgery in the second surgical procedure. There was no difference in mortality, nor any other outcome including organ failure and infections.

Conclusions

When in severely injured patients treatment is dictated by physiology into either early definitive surgery or damage control with multiple shorter procedures stretched over several days combined with aggressive resuscitation with blood products, outcome is comparable in terms of complications.

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Title: Physiology dictated treatment after severe trauma: timing is everything
Authors: Karlijn J. P. van Wessem
Luke P. H. Leenen
Falco Hietbrink
Publication date: 26-02-2022
Publisher: Springer Berlin Heidelberg
Keywords: Central Nervous System Trauma
Care
Published in: European Journal of Trauma and Emergency Surgery / Issue 5/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-022-01916-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Physiology dictated treatment after severe trauma: timing is everything

Abstract

Introduction

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

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