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Early management of severe abdominal trauma.

Authors
  • Bouzat, Pierre1
  • Valdenaire, Guillaume2
  • Gauss, Tobias3
  • Charbit, Jonhatan4
  • Arvieux, Catherine5
  • Balandraud, Paul6
  • Bobbia, Xavier7
  • David, Jean-Stéphane8
  • Frandon, Julien9
  • Garrigue, Delphine10
  • Long, Jean-Alexandre11
  • Pottecher, Julien12
  • Prunet, Bertrand13
  • Simonnet, Bruno2
  • Tazarourte, Karim14
  • Trésallet, Christophe15
  • Vaux, Julien16
  • Viglino, Damien17
  • Villoing, Barbara18
  • Zieleskiewicz, Laurent19
  • And 2 more
  • 1 Pôle d'Anesthésie-Réanimation, Hôpital Albert-Michallon, CHU Grenoble Alpes, 38700 La Tronche, France. Electronic address: [email protected] , (France)
  • 2 University Hospital of Bordeaux, Pole of Emergency Medicine, 33076 Bordeaux, France. , (France)
  • 3 Department of Anaesthesia and Intensive Care, Beaujon Hospital, hôpitaux-Paris-Nord-Val-De-Seine, AP-HP, 92110 Clichy, France. , (France)
  • 4 Trauma Intensive and Critical Care Unit, Department of Anesthesiology and Critical Care, Lapeyronie Hospital, Montpellier I University, 34000 Montpellier, France. , (France)
  • 5 Grenoble Alps Trauma Centre, Grenoble University Hospital, Grenoble Alps University, 38000, Grenoble, France. , (France)
  • 6 Department of Surgery, French Military Medical Academy, École du Val-de-Grâce, 75005 Paris, France. , (France)
  • 7 Department of Anaesthesiology, Emergency and Critical Care Medicine, Intensive Care Unit, Nîmes University Hospital, place du Pr Debré 30029 Nîmes, France. , (France)
  • 8 Service D'anesthésie Réanimation, Centre Hospitalier Lyon Sud, 69495 Pierre-Bénite Cedex, France. , (France)
  • 9 Department of radiology, Nîmes University Hospital, 30029 Nîmes, France. , (France)
  • 10 CHU Lille, Pôle de l'Urgence, 59000 Lille, France. , (France)
  • 11 Department of Urology, Grenoble University Hospital, Grenoble Alps University, 38000, Grenoble, France. , (France)
  • 12 Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d'Anesthésie-Réanimation Chirurgicale-Université de Strasbourg, Faculté de Médecine, Fédération de Médecine Translationnelle de Strasbourg (FMTS), 67000 Strasbourg, France. , (France)
  • 13 Bureau de Médecine D'urgence, Brigade de Sapeurs-pompiers de Paris, 75000 Paris, France. , (France)
  • 14 Univ Lyon, HESPER EA 7425, Hospices civils de Lyon, Département de Médecine D'urgence, Centre Hospitalier Herriot, 69003, Lyon, France. , (France)
  • 15 Sorbonne Université, UMR CNRS-Inserm U678, Assistance Publique des Hôpitaux de Paris (AP-HP), Service de Chirurgie Générale, Viscérale et Endocrinienne, Hôpital de la Pitié-Salpêtrière, 75013 Paris, France. , (France)
  • 16 Assistance Publique des Hôpitaux de Paris (AP-HP), Hôpital Universitaire Henri-Mondor, SAMU94, 94000 Créteil, France. , (France)
  • 17 Department of Emergency Medicine, Grenoble University Hospital, Grenoble Alps University, 38000, Grenoble, France. , (France)
  • 18 Urgences-Smur, Cochin-Hôtel-Dieu, AP-HP, 75014 Paris, France. , (France)
  • 19 Département Anesthésie-Réanimation, Assistance publique-Hopitaux de Marseille, Hôpital Nord, 13000 Marseille, France. , (France)
  • 20 University Hospital of Bordeaux, Pole of Emergency Medicine, 33076 Bordeaux, France; University of Bordeaux, Bordeaux Population Health, Injury Epidemiology Trauma and Occupation Team, Inserm U1219, 33076 Bordeaux, France. , (France)
  • 21 Service d'Anesthésie-Réanimation, Hôpital Beaujon, UMR_S1149, Centre De Recherche Sur L'inflammation, Inserm et Université Paris Diderot, AP-HP, 75000 Paris, France. , (France)
Type
Published Article
Journal
Anaesthesia, critical care & pain medicine
Publication Date
Apr 01, 2020
Volume
39
Issue
2
Pages
269–277
Identifiers
DOI: 10.1016/j.accpm.2019.12.001
PMID: 31843714
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To develop French guidelines on the management of patients with severe abdominal trauma. A consensus committee of 20 experts from the French Society of Anaesthesiology and Critical Care Medicine (Société française d'anesthésie et de réanimation, SFAR), the French Society of Emergency Medicine (Société française de médecine d'urgence, SFMU), the French Society of Urology (Société française d'urologie, SFU) and from the French Association of Surgery (Association française de chirurgie, AFC), the Val-de-Grâce School (École du Val-De-Grâce, EVG) and the Federation for Interventional Radiology (Fédération de radiologie interventionnelle, FRI-SFR) was convened. Declaration of all conflicts of interest (COI) policy by all participants was mandatory throughout the development of the guidelines. The entire guideline process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system for assessment of the available level of evidence with particular emphasis to avoid formulating strong recommendations in the absence of high level. Some recommendations were left ungraded. The guidelines are divided in diagnostic and, therapeutic strategy and early surveillance. All questions were formulated according to Population, Intervention, Comparison, and Outcomes (PICO) format. The panel focused on three questions for diagnostic strategy: (1) What is the diagnostic performance of clinical signs to suggest abdominal injury in trauma patients? (2) Suspecting abdominal trauma, what is the diagnostic performance of prehospital FAST (Focused Abdominal Sonography for Trauma) to rule in abdominal injury and guide the prehospital triage of the patient? and (3) When suspecting abdominal trauma, does carrying out a contrast enhanced thoraco-abdominal CT scan allow identification of abdominal injuries and reduction of mortality? Four questions dealt with therapeutic strategy: (1) After severe abdominal trauma, does immediate laparotomy reduce morbidity and mortality? (2) Does a "damage control surgery" strategy decrease morbidity and mortality in patients with a severe abdominal trauma? (3) Does a laparoscopic approach in patients with abdominal trauma decrease mortality or morbidity? and (4) Does non-operative management of patients with abdominal trauma without bleeding reduce mortality and morbidity? Finally, one question was formulated regarding the early monitoring of these patients: In case of severe abdominal trauma, which kind of initial monitoring does allow to reduce the morbi-mortality? The analysis of the literature and the recommendations were conducted following the GRADE® methodology. The SFAR/SFMU Guideline panel provided 15 statements on early management of severe abdominal trauma. After three rounds of discussion and various amendments, a strong agreement was reached for 100% of recommendations. Of these recommendations, five have a high level of evidence (Grade 1±), six have a low level of evidence (Grade 2±) and four are expert judgments. Finally, no recommendation was provided for one question. Substantial agreement exists among experts regarding many strong recommendations for the best early management of severe abdominal trauma. Copyright © 2019 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

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