Damage control resuscitation: early decision strategies in abdominal gunshot wounds using an easy "ABCD" mnemonic.

BACKGROUND

Early damage-control resuscitation (DCR) indicators have not been clearly discerned in patients with penetrating abdominal trauma. Our objective was to identify these clinical indicators that could standardize a DCR initiation policy in this subset of patients.

METHODS

Prospective data collection from January 2003 to October 2010 at a Level I trauma center in Cali, Colombia. All adult (>15 years) patients with abdominal gunshot wounds (GSWs) were included. They were divided into two groups: those who underwent DCR and those who did not. Both groups were compared by demographics, clinical variables, severity scores, and overall mortality. Other scores were compared with our newly devised model using the area under the receiver operating characteristic curve (AUROC).

RESULTS

There was a total of 331 abdominal GSWs. Of these, a total of 162 (49%) underwent DCR. The overall mortality was 11.2%. Multivariate analysis identified (A) acidosis (base deficit ≥ 8); (B) blood loss (hemoperitoneum > 1,500 mL); (C) cold (temperature < 35 °C); (D) damage (New Injury Severity Score > 35) as significant clinical indicators that aided in the decision process of early implementation of DCR. The Trauma-Associated Severe Hemorrhage (AUROC, 0.8333), McLaughlin (AUROC, 0.8148), ABC (AUROC, 0.7372) scores and our ABCD mnemonic (AUROC, 0.8745) were all good predictors of DCR, and the difference between them was statistically significant (p < 0.001).

CONCLUSION

We have identified (A) acidosis (base deficit ≥ 8); (B) blood loss (hemoperitoneum > 1,500 mL); (C) cold (temperature < 35 °C); (D) damage (New Injury Severity Score > 35) as significant clinical indicators that aided in the decision process of early implementation of DCR for patients with abdominal GSWs.

LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III.