Identification and Evaluation of the Indications for Use of Damage Control Surgery and Damage Control Interventions in Civilian Trauma Patients

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atmire.migration.oldid3162
dc.contributor.advisorZygun, David
dc.contributor.advisorStelfox, Henry
dc.contributor.authorRoberts, Derek
dc.date.accessioned2015-04-30T22:06:53Z
dc.date.embargolift2018-04-29T22:06:53Z
dc.date.issued2015-04-30
dc.date.submitted2015en
dc.description.abstractAlthough damage control (DC) surgery may improve survival in select, severely injured patients, the procedure is associated with significant morbidity, and therefore should only be used when appropriately indicated. The objective of this thesis was to identify and evaluate candidate indications for use of DC surgery and DC interventions in civilian trauma patients. We conducted a scoping review to identify candidate indications. Among 27,732 citations identified by the search, we included 270 articles that reported 1,107 indications for DC surgery and 424 indications for 16 DC interventions. We conducted a content analysis to synthesize these indications into 123 named, content-characteristic codes representing unique indications for DC surgery and 101 codes representing unique indications for DC interventions. An international panel of trauma surgery experts (n=9) subsequently assessed 101 (82.1%) of the coded indications for DC surgery and 78 (77.2%) of the coded indications for DC interventions to be appropriate. We conducted a systematic review to identify studies reporting data on the reliability or validity of indications or that assessed outcomes associated with utilization of an indication or indications or the conduct of DC versus definitive surgery for one or more indications. Among 31,014 citations identified, we included 36 studies that evaluated 79 unique indications. Of these, 19 had evidence of face validity or predictive criterion validity, six had evidence supporting that they were associated with improved survival when utilized or when DC was conducted instead of definitive surgery, and three had evidence suggesting that they were associated with reduced survival which may be improved with DC surgery. Finally, we conducted a cross-sectional survey of trauma centers and surgeons located in the United States, Canada, and Australasia. In total, 232 (64.8%) trauma centers responded. These centers nominated 366 surgeons to survey about indications for DC surgery, of whom 201 (56.0%) responded. Respondents assessed 15 (78.9%) preoperative and 23 (95.8%) intraoperative indications to be appropriate. The list of candidate indications for use of DC surgery and DC interventions identified in this thesis may provide a practical foundation to guide surgical practice while studies are conducted to evaluate their impact on patient outcomes.en_US
dc.description.embargoterms3 yearsen_US
dc.identifier.citationRoberts, D. (2015). Identification and Evaluation of the Indications for Use of Damage Control Surgery and Damage Control Interventions in Civilian Trauma Patients (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/26420en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/26420
dc.identifier.urihttp://hdl.handle.net/11023/2206
dc.language.isoeng
dc.publisher.facultyGraduate Studies
dc.publisher.institutionUniversity of Calgaryen
dc.publisher.placeCalgaryen
dc.rightsUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subjectEpidemiology
dc.subjectHealth Care Management
dc.subjectMedicine and Surgery
dc.subject.classificationDamage Control Surgeryen_US
dc.subject.classificationDamage Control Interventionsen_US
dc.subject.classificationIndicationsen_US
dc.subject.classificationScoping Reviewen_US
dc.subject.classificationContent Analysisen_US
dc.subject.classificationExpert Appropriateness Rating Studyen_US
dc.subject.classificationSystematic Reviewen_US
dc.subject.classificationCross-Sectional Surveyen_US
dc.subject.classificationMixed-Methods Studyen_US
dc.titleIdentification and Evaluation of the Indications for Use of Damage Control Surgery and Damage Control Interventions in Civilian Trauma Patients
dc.typedoctoral thesis
thesis.degree.disciplineCommunity Health Sciences
thesis.degree.grantorUniversity of Calgary
thesis.degree.nameDoctor of Philosophy (PhD)
ucalgary.item.requestcopytrue
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