With recent advances in ICU management, DCL is usually followed by organized and protocolized treatment plans, bridging the initial damage control procedure to definite treatment [5]. DCL provides critically ill patients with the best chance of survival, expands the interval for other life-saving interventions, and prepares patients for a secondary laparotomy. Between the first damage control procedure and the secondary laparotomy, ICU physicians always make their best effort to develop a thorough treatment plan, from maintaining the patient with good oxygenation

to the sophisticated tuning of resuscitation details [6]. In Selleck Ku-0059436 addition, adjuvant hemostatic procedures, such as trans-arterial embolization (TAE) [7], are sometimes necessary for better hemostatic effect. Even with advanced ICU management and successful hemostasis, however, some of those patients still succumb later to their complicated clinical course. In this study, we will explore the possible causes of death and risk

factors in patients who survived the initial critical circumstance but succumbed to the later clinical course. Methods and materials Clinical setting Chang Gung Memorial Hospital (CGMH) is a level I trauma center in northern Taiwan. From May 2008 to June 2012, 1203 patients sustained abdominal trauma, and 336 patients underwent surgery (either a laparotomy or a laparoscopic procedure). At CGMH, we not only have a 24-hour specialized trauma team but also have standard protocols for all different types of major trauma over 10 years. In addition, emergent TAE is widely used Selleck PD0332991 in our institute

and has been available at any hour for the past decade. For patients with solid organ injury (including hepatic, renal, and splenic injuries), approximately 90% of non-operative management was conducted with a low failure rate (< 2%). For patients with intra-abdominal bleeding, we only performed laparotomy for refractory hemorrhagic shock, multiple bleeding sites with difficult TAE approaching, and either a complete failure or temporary benefit of TAE. Inclusion criteria In this study, we excluded patients aged less than 18 and over 65, patients who arrived at the emergency department (ED) 6 hours after the traumatic incident, pregnant patients, patients with end-stage renal disease, and patients with congestive OSBPL9 heart failure. In addition, we also excluded patients who underwent DCL after ICU admission or later during their hospital stay. Only patients who suffered from blunt or penetrating abdominal trauma and were later sent to operation room (OR) directly from the ED were enrolled for further analysis. We defined late death as patients who died 48 hours or later after DCL with successful hemostasis. Study design This was a retrospective study and was approved by the local institutional review board of CGMH. The Trauma Registration System of CGMH was started from May 2008.