Where should the damage control surgery be performed, at the nearest health center or at a fully equipped hospital?

BACKGROUND: Transport of casualties from a combat area to a fully equipped hospital where all techniques of damage control surgery (DCS) can be performed requires a great deal of time. Therefore, prior to transport, prompt control of hemorrhage and contamination should be achieved, and resuscitative procedures should be performed at the nearest health center. The aim of the present study was to investigate the effect of the location at which DCS was performed on rates of mortality.
METHODS: The present retrospective study included 51 combat casualties who underwent DCS at the present clinic or at hospitals nearest the combat area due to high kinetic energy gunshot injuries to the abdomen between 2010 and 2015. Patients were evaluated in terms of acidosis, hypothermia, coagulopathy, and mortality.
RESULTS: Patients were divided into 2 groups depending on the location where the first step of DCS was performed: (1) at the present hospital or (2) at other hospitals. Group 1 comprised 26 patients (51%), and Group 2 comprised 25 (49%). Total mortality occurred in 23 (45.1%) patients, including 15 (57.7%) patients in Group 1 and 8 (32%) in Group 2. In Group 1, mean time from injury to hospital admission was longer, and deep acidosis, hypothermia, and coagulopathy were more marked.
CONCLUSION: Initial surgical control of hemorrhage and contamination in patients injured by high kinetic gunshots should be promptly achieved at the nearest health center. In this way, acidosis, hypothermia, and coagulopathy can be prevented, and the risk of mortality can be reduced.

Hasar kontrol cerrahisi nerede yapýlmalý? Yapýlabilecek en yakýn yerde mi, tam donanýmlý hastanede mi?

AMAÇ: Savaþ koþullarýnda ciddi þekilde yaralanmýþ hastalarý hasar kontrol cerrahisinin tüm aþamalarýný baþarýyla yapabilecek tam donanýmlý hastanelere nakletmek için uzun süreye ihtiyaç vardýr. Bu nedenle savaþta yaralananlar ya yaralanma alanýna yakýn birimlerde kanama ve kontaminasyon kontrolü saðlanarak yada sadece resusitatif iþlemler yapýlarak tam donanýmlý hastanelere sevk edilmektedir. Bu çalýþmanýn amacý hasar kontrol cerrahisinin yapýldýðý yer ile mortalite arasýndaki iliþkiyi belirlemektir.
GEREÇ VE YÖNTEM: Bu çalýþmaya 2010–2015 yýllarý arasýnda abdominal bölgeden yüksek kinetik enerjili ateþli silahlarla yaralandýktan sonra hastanemizde ya da yaralanma yerine daha yakýn diðer hastanelerde hasar kontrol cerrahisi yapýlan 51 hasta dahil edildi. Hastalar hasar kontrol cerrahisinin ilk aþamasýný olduklarý yere göre gruplandýrýlarak asidoz, hipotermi, koagülopati ve mortalilte açýsýndan deðerlendirildi.
BULGULAR: Ýlk ameliyatý hastanemizde olanlarýn sayýsý 26’idi (%51). Diðer hastanelerde ameliyat olanlarýn sayýsý 25’di (%49). Tüm hastalarýn %45.1’i (n=23) kaybedildi. Ýlk ameliyatý hastanemizde yapýlanlarýn %57.7’si (n=15); diðer hastanelerde yapýlanlarýn %32.0’si (n=8) kaybedildi. Hastanemizde ameliyat olanlarda baþvuru zamaný daha uzundu. Asidoz, hipotermi ve koagülopati daha belirgindi.
TARTIÞMA: Abdominal bölgeden yüksek kinetik enerjili silahlarla yaralananlarda kanama ve kontaminasyonun erken kontrolü yapýlabilecek en yakýn yerde gerçekleþtirilmelidir. Bu uygulama asidoz, hipotermi ve koagülopati geliþmesini önleyebilir ve böylece mortalite oranýnýn düþürülmesinde etkili olabilir.