Surgical treatment strategies in pediatric trauma patients: ETC vs. DCO-an analysis of 316 pediatric trauma patients from the TraumaRegister DGU(®).

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Abstract

[Indexed for MEDLINE] 8. Eur Surg Res. 2024;65(1):115-122. doi: 10.1159/000541399. Epub 2024 Sep 30. Damage Control Orthopaedics Induced Less Trauma-Induced Coagulopathy than Early Total Care in a Porcine Polytrauma Model. Mert Ü(1)(2), Groven RVM(1)(3)(4), Greven J(5), He Z(5), Mahmoud MA(1), van Griensven M(3), Huber-Lang M(6), Mollnes TE(7)(8), Rosado Balmayor E(5), Horst K(1), Hildebrand F(1). Author information: (1)Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, Aachen, Germany. (2)Department of Orthopaedics and Trauma Surgery, Helios University Hospital, University Witten/Herdecke, Wuppertal, Germany. (3)Department of Cell Biology-Inspired Tissue Engineering, MERLN Institute for Technology-Inspired Regenerative Medicine, Maastricht University, Maastricht, The Netherlands. (4)Division of Trauma Surgery, Department of Surgery, Maastricht University Medical Center+, Maastricht, The Netherlands. (5)Experimental Orthopaedics and Trauma Surgery, Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University, Aachen, Germany. (6)Institute of Clinical and Experimental Trauma-Immunology, University of Ulm, Ulm, Germany. (7)Research Laboratory, Nordland Hospital Bodø, Bodø, Norway. (8)Department of Immunology, Oslo University Hospital and University of Oslo, Oslo, Norway. INTRODUCTION: Coagulopathic disorders (CDs) complicate treatment in polytraumatised patients. Against this background, operative strategies for fracture management are controversial in this cohort. This study therefore investigated the effects of two established operative concepts, early total care (ETC) and damage control orthopaedics (DCO), on CD in a large-animal polytrauma (PT) model. METHODS: Twenty-two animals (Sus scrofa domesticus) sustained PT involving blunt-chest trauma, liver laceration, bilateral femur fracture, and pressure-controlled haemorrhagic shock. After resuscitation, animals were allocated to ETC (n = 8), DCO (n = 8), or served as a non-traumatised control group (CG, n = 6). Animals were ventilated and monitored under ICU standards for 72 h. Blood samples were collected at baseline and post-trauma after 1.5, 2.5, 24, 48, and 72 h. Plasminogen activator inhibitor-1 (PAI-1) and thrombin-antithrombin (TAT) complex concentrations were determined by ELISA. RESULTS: Compared to the CG, ETC and DCO subjects had significantly increased plasma concentrations of PAI-1 after 2.5 h (CG vs. ETC: p = 0.0050, CG vs. DCO: p = 0.0016). Furthermore, the ETC group showed significantly increased plasma PAI-1 concentrations after 24 h compared to the CG and DCO groups (CG vs. ETC: p = 0.0002, DCO vs. ETC: p = 0.0004). During the later clinical course, concentrations of TAT were significantly increased in the ETC group compared to the CG and DCO group after 72 h (CG vs. ETC: p = 0.0290, DCO vs. ETC: p = 0.0322). CONCLUSION: PT is strongly associated with CD in the early post-traumatic course. In comparison to DCO, ETC appeared to be negatively associated with CD. Future studies must investigate this impact, especially in those patients admitted with trauma-induced coagulopathy, to improve outcomes. © 2024 The Author(s). Published by S. Karger AG, Basel. DOI: 10.1159/000541399