DAMAGE CONTROL VERSUS EARLY DEFINITIVE SURGERY IN PEDIATRIC AND ADOLESCENT TRAUMA: A SYSTEMATIC REVIEW OF OUTCOMES AND STRATEGIES

Abstract Background: Whether damage control strategies (damage control surgery/laparotomy [DCS/DCL] or damage control orthopedics [DCO]) confer outcome advantages over early definitive surgery (EDS/ETC) in pediatric and adolescent trauma remains uncertain. Methods: We conducted a targeted systematic review of eight original studies, including registry analyses, national database studies, single-center cohorts, an audit, a technique series, and a case report involving injured children/adolescents requiring operative care. Outcomes included mortality, complications, length of stay (LOS), closure outcomes for open abdomen, and health-care utilization. Narrative synthesis was performed due to heterogeneity. Risk of bias was appraised qualitatively. Results: Across cohorts, DCL/DCS utilization in operative pediatric abdominal trauma ranged from 11–15% and was associated with worse presenting physiology and higher injury severity; compared with definitive laparotomy, DCL/DCS carried higher mortality (9% vs 2%) and longer LOS (17 vs 8 days) in national data, consistent with confounding by indication [13]. A national cohort of pediatric TBI with femur fracture reported DCO use in 14.9% with higher odds of inpatient death (OR=2.8) and resource utilization versus ETC after adjustment [7]. Open-abdomen series showed high survival (=93%) and feasible primary closure in many cases [10]. Registry data on long-bone/orthopedic stabilization suggested ETC predominance in younger children with no clear outcome detriment versus adults [6]. Conclusions: In pediatric trauma, DCL/DCS/DCO are used selectively for sicker patients and, unsurprisingly, track with higher crude adverse outcomes versus EDS/ETC. Evidence remains observational; standardized outcomes and pediatric-specific indications are needed.