Abstract

GOMEZ SANTOS, Germán  and  CAMACHO ANGEL, Elver Alirio. Surgery for damage control. Abdominal trauma score as predictive factor. rev. colomb. cir. [online]. 2004, vol.19, n.2, pp.85-91. ISSN 2011-7582.

The treatment of the patient with severe trauma with lesions in multiple organs represents one of the most complex and serious challenges for the surgeon. The advent of damage control surgery has resulted in better survival (from 34% to 52% in the past years) as reported in the literature. We conducted a study over seven years, from January 1 1996 to November 30 2002, including 1975 laparotomies for trauma. Damage control surgery was performed in 149 patients (8.3%) with the most severe lesions. Mechanism of trauma was: blunt trauma (n: 25, 17%), gunshot wounds (n: 83, 56%), stab wounds (n: 35, 23%), and wounds by multiple charge arms (n: 6, 4%). There were 124 men and 25 women. 75% of the patients presented with preoperative shock and 91% developed shock during surgery; 8% developed cardiorespiratory arrest before surgery and 28% during surgery. Resuscitation thoracotomy was performed in 54 patients (36%); clamping of the aorta was necessary in 75% of the patients. The most frequently traumatized organ was the liver, 77% of cases. We found that patients with abdominal trauma score >60 exhibited a mortality rate of 60%; when the score was 30-59, the mortality rate was 60%; and when the score was <30 and bleeding <200 ml, the survival rate was 100%.

Keywords : damage control; abdominal trauma; prediction of mortality.

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