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Bath MF, Kohler K, Hobbs L, Smith BG, Clark DJ, Kwizera A, Perkins Z, Marsden M, Davenport R, Davies J, Amoako J, Moonesinghe R, Weiser T, Leather AJM, Hardcastle T, Naidoo R, Nördin Y, Conway Morris A, Lakhoo K, Hutchinson PJ, Bashford T. Evaluating patient factors, operative management and postoperative outcomes in trauma laparotomy patients worldwide: a protocol for a global observational multicentre trauma study. BMJ Open 2024; 14:e083135. [PMID: 38580358 PMCID: PMC11002395 DOI: 10.1136/bmjopen-2023-083135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/05/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Trauma contributes to the greatest loss of disability-adjusted life-years for adolescents and young adults worldwide. In the context of global abdominal trauma, the trauma laparotomy is the most commonly performed operation. Variation likely exists in how these patients are managed and their subsequent outcomes, yet very little global data on the topic currently exists. The objective of the GOAL-Trauma study is to evaluate both patient and injury factors for those undergoing trauma laparotomy, their clinical management and postoperative outcomes. METHODS We describe a planned prospective multicentre observational cohort study of patients undergoing trauma laparotomy. We will include patients of all ages who present to hospital with a blunt or penetrating injury and undergo a trauma laparotomy within 5 days of presentation to the treating centre. The study will collect system, patient, process and outcome data, following patients up until 30 days postoperatively (or until discharge or death, whichever is first). Our sample size calculation suggests we will need to recruit 552 patients from approximately 150 recruiting centres. DISCUSSION The GOAL-Trauma study will provide a global snapshot of the current management and outcomes for patients undergoing a trauma laparotomy. It will also provide insight into the variation seen in the time delays for receiving care, the disease and patient factors present, and patient outcomes. For current standards of trauma care to be improved worldwide, a greater understanding of the current state of trauma laparotomy care is paramount if appropriate interventions and targets are to be identified and implemented.
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Affiliation(s)
- Michael F Bath
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
| | - Katharina Kohler
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Laura Hobbs
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- Department of Anaesthesia, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Brandon George Smith
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
| | - David J Clark
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Arthur Kwizera
- Department of Anesthesia, Makerere University, Kampala, Uganda
| | - Zane Perkins
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Major Trauma Service, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Max Marsden
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Academic Department of Military Surgery and Trauma, Research and Clinical Innovation, Defence Medical Services, Birmingham, UK
| | - Ross Davenport
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
- Major Trauma Service, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Justin Davies
- Cambridge Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Joachim Amoako
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
- University of Ghana Medical School, Accra, Ghana
| | - Ramani Moonesinghe
- National Clinical Director for Critical and Perioperative Care, NHS England, London, UK
| | - Thomas Weiser
- Department of Surgery, Stanford University, Palo Alto, California, USA
| | - Andy J M Leather
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Timothy Hardcastle
- Department of Surgical Sciences, Mandela School of Medicine (NRMSM), University of KwaZulu-Natal, Durban, South Africa
- Trauma and Burns Unit, Inkosi Albert Luthuli Central Hospital, KwaZulu-Natal Department of Health, Durban, South Africa
| | - Ravi Naidoo
- Department of Surgery, Ngwelezana Hospital, Empangeni, South Africa
| | - Yannick Nördin
- Emergency Medical Care System (SAMU), Jalisco State, Mexico
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Kokila Lakhoo
- Department of Paediatric Surgery, University of Oxford, Oxford, UK
| | - Peter John Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Acquired Brain and Spine Injury, Cambridge, UK
| | - Tom Bashford
- International Health Systems Group, Department of Engineering, University of Cambridge, Cambridge, UK
- Department of Anaesthesia, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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van Wessem KJP, Leenen LPH, Hietbrink F. Physiology dictated treatment after severe trauma: timing is everything. Eur J Trauma Emerg Surg 2022; 48:3969-3979. [PMID: 35218406 PMCID: PMC9532323 DOI: 10.1007/s00068-022-01916-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/12/2022] [Indexed: 11/25/2022]
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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Affiliation(s)
- Karlijn J P van Wessem
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Luke P H Leenen
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Falco Hietbrink
- Department of Trauma Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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