It is unknown how frequently damage control (DC) laparotomy is used across trauma centers in different countries. We conducted a cross-sectional survey of trauma centers in the United States, Canada, and Australasia to study variations in use of the procedure and predictors of more frequent use of DC laparotomy. A self-administered, electronic, cross-sectional survey of trauma centers in the United States, Canada, and Australasia was conducted. The survey collected information about trauma center and program characteristics. It also asked how often the trauma program director estimated DC laparotomy was performed on injured patients at that center on average over the last year. Multivariable logistic regression was used to identify predictors of a higher reported frequency of use of DC laparotomy. Of the 366 potentially eligible trauma centers sent the survey, 199 (51.8%) trauma program directors or leaders responded [United States = 156 (78.4%), Canada = 26 (13.1%), and Australasia = 17 (8.5%)]. The reported frequency of use of DC laparotomy was highly variable across trauma centers. DC laparotomy was used more frequently in level-1 than level-2 or -3 trauma centers. Further, high-volume level-1 centers used DC laparotomy significantly more often than lower volume level-1 centers (p = 0.02). Nearly half (48.4%) of high-volume volume level-1 trauma centers reported using the procedure at least once weekly. Significant adjusted predictors of more frequent use of DC laparotomy included country of origin [odds ratio (OR) for the United States vs. Canada = 7.49; 95% confidence interval (CI) 1.39–40.27], level-1 verification status (OR = 6.02; 95% CI 2.01–18.06), and the assessment of a higher number of severely injured (Injury Severity Scale score > 15) patients (OR per-100 patients = 1.62; 95% CI 1.20–2.18) and patients with penetrating injuries (OR per-5% increase = 1.27; 95% CI 1.01–1.58) in the last year. The reported frequency of use of DC laparotomy was highly variable across trauma centers. Those centers that most need to evaluate the benefit-to-risk ratio of using DC laparotomy in different scenarios may include high-volume, level-1 trauma centers, particularly those that often manage penetrating injuries.

中文翻译：

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美国、加拿大和大洋洲创伤中心对损伤控制性剖腹手术的使用差异

目前尚不清楚不同国家的创伤中心使用损伤控制 (DC) 剖腹手术的频率。我们对美国、加拿大和大洋洲的创伤中心进行了一项横断面调查，以研究手术使用的变化以及更频繁地使用 DC 剖腹手术的预测因素。对美国、加拿大和大洋洲的创伤中心进行了一项自我管理的电子横断面调查。该调查收集了有关创伤中心和项目特征的信息。它还询问创伤项目主任估计，去年该中心的受伤患者平均多久进行一次 DC 剖腹手术。多变量逻辑回归用于确定报告使用 DC 剖腹手术频率较高的预测因子。在发送调查的 366 家可能符合条件的创伤中心中，199 名 (51.8%) 创伤项目负责人或领导者做出了回应 [美国 = 156 (78.4%)，加拿大 = 26 (13.1%)，大洋洲 = 17 (8.5%)]。报告的使用 DC 剖腹手术的频率在各个创伤中心存在很大差异。DC 剖腹术在 1 级创伤中心的使用频率高于 2 级或 -3 级创伤中心。此外，高容量 1 级中心比低容量 1 级中心更频繁地使用 DC 剖腹手术 (p = 0.02)。近一半 (48.4%) 的高容量 1 级创伤中心报告说每周至少使用一次该程序。更频繁使用 DC 剖腹术的显着调整预测因素包括原产国 [美国与加拿大的优势比 (OR) = 7.49；95% 置信区间 (CI) 1.39–40.27]，1 级验证状态（OR = 6.02；95% CI 2.01–18.06)，以及对更多严重受伤（损伤严重程度量表评分 > 15）患者（OR 每 100 名患者 = 1.62；95% CI 1.20–2.18）和穿透伤患者（OR去年每增加 5% = 1.27；95% CI 1.01–1.58)。报告的使用 DC 剖腹手术的频率在各个创伤中心存在很大差异。那些最需要评估在不同情况下使用 DC 剖腹手术的效益风险比的中心可能包括高容量的 1 级创伤中心，特别是那些经常处理穿透伤的中心。报告的使用 DC 剖腹手术的频率在各个创伤中心存在很大差异。那些最需要评估在不同情况下使用 DC 剖腹手术的效益风险比的中心可能包括高容量的 1 级创伤中心，特别是那些经常处理穿透伤的中心。报告的使用 DC 剖腹手术的频率在各个创伤中心存在很大差异。那些最需要评估在不同情况下使用 DC 剖腹手术的效益风险比的中心可能包括高容量的 1 级创伤中心，特别是那些经常处理穿透伤的中心。