Although damage control (DC) surgery is widely assumed to reduce mortality in critically injured patients, survivors often suffer substantial morbidity, suggesting that it should only be used when indicated. The purpose of this systematic review was to determine which indications for DC have evidence that they are reliable and/or valid (and therefore in which clinical situations evidence supports use of DC or that DC improves outcomes). We searched 11 databases (1950–April 1, 2019) for studies that enrolled exclusively civilian trauma patients and reported data on the reliability (consistency of surgical decisions in a given clinical scenario) or content (surgeons would perform DC in that clinical scenario or the indication predicted use of DC in practice), construct (were associated with poor outcomes), or criterion (were associated with improved outcomes when DC was conducted instead of definitive surgery) validity for suggested indications for DC surgery or DC interventions. Among 34,979 citations identified, we included 36 cohort studies and three cross-sectional surveys in the systematic review. Of the 59 unique indications for DC identified, 10 had evidence of content validity [e.g., a major abdominal vascular injury or a packed red blood cell (PRBC) volume exceeding the critical administration threshold], nine had evidence of construct validity (e.g., unstable patients with combined abdominal vascular and pancreas gunshot injuries or an iliac vessel injury and intraoperative acidosis), and six had evidence of criterion validity (e.g., penetrating trauma patients requiring > 10 U PRBCs with an abdominal vascular and multiple abdominal visceral injuries or intraoperative hypothermia, acidosis, or coagulopathy). No studies evaluated the reliability of indications. Few indications for DC surgery or DC interventions have evidence supporting that they are reliable and/or valid. DC should be used with respect for the uncertainty regarding its effectiveness, and only in circumstances where definitive surgery cannot be entertained.

中文翻译：

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在平民创伤患者中使用损伤控制手术和损伤控制干预的证据：系统评价

尽管人们普遍认为损伤控制 (DC) 手术可以降低重伤患者的死亡率，但幸存者通常会出现严重的并发症，这表明它仅应在有指征时使用。本系统评价的目的是确定 DC 的哪些适应症有证据表明它们是可靠和/或有效的（因此在哪些临床情况下证据支持使用 DC 或 DC 可改善结果）。我们在 11 个数据库（1950 年至 2019 年 4 月 1 日）中搜索了专门招募平民创伤患者的研究，并报告了可靠性（给定临床情况下手术决定的一致性）或内容（外科医生将在该临床情况下或指征预测 DC 在实践中的使用），构建（与不良结果相关），DC 手术或 DC 干预的建议适应症的有效性或标准（当进行 DC 而非确定性手术时与改善的结果相关）有效性。在确定的 34,979 篇引文中，我们在系统评价中纳入了 36 项队列研究和三项横断面调查。在确定的 59 个 DC 独特适应症中，10 个具有内容有效性的证据[例如，严重的腹部血管损伤或浓缩红细胞 (PRBC) 量超过了临界给药阈值]，9 个具有结构有效性的证据（例如，不稳定合并腹部血管和胰腺枪伤或髂血管损伤和术中酸中毒的患者），6 名具有标准有效性的证据（例如，穿透性创伤患者需要 > 10 U PRBC 伴有腹部血管和多处腹部内脏损伤或术中体温过低、酸中毒或凝血病）。没有研究评估适应症的可靠性。很少有 DC 手术或 DC 干预的指征有证据支持它们是可靠和/或有效的。DC 应考虑其有效性的不确定性，并且仅在不能接受确定性手术的情况下使用。