Damage-Control Surgery Versus Early Definitive Management in Pediatric and Adolescent Trauma: A Systematic Review of Outcomes and Strategies

Abstract

Study aim: we aimed to explore whether damage control strategies, damage control laparotomy, surgery (DCL, DCS) and damage control orthopedics (DCO), improve outcomes compared with early definitive surgery and early total care (EDS, ETC) in injured children and adolescents. Methods: We performed a systematic review of eight original studies (national databases, registries, single-center cohorts, an audit, a technique series, and a case report) including pediatric and adolescent trauma patients who required operative care. Reported outcomes included mortality, complications, length of stay (LOS), open-abdomen closure, and health-care use. Owing to heterogeneity, we used narrative synthesis and qualitatively appraised risk of bias. Results: Among children needing urgent laparotomy, DCL was used in 12–15% and was chosen for patients with worse physiology and higher injury severity. Compared with definitive laparotomy, DCL showed higher crude mortality (9% vs 2%) and longer LOS (17 vs 8 days), reflecting confounding by indication. In a national cohort of traumatic brain injury with femur fracture, DCO (15%) was associated with higher adjusted odds of inpatient death and resource use than ETC. Modern pediatric open-abdomen series reported high survival (93%) with primary fascial closure achievable in many cases, though prolonged open abdomen increased infection risk. Conclusions: In pediatric trauma, DCL, DCS, DCO are applied to the sickest patients and track with worse crude outcomes versus EDS, ETC, largely due to illness severity. Pediatric-specific indications and standardized outcome reporting are needed.