Beale et al identified a number of risk factors associated with an inability to achieve primary abdominal closure in a trauma patient with an open abdomen. The authors are from the University of Texas Southwestern Medical Center and Parkland Memorial Hospital in Dallas.


Patient selection: trauma patient with damage control surgery resulting in an open abdomen


Predictors of a failure to achieve primary closure of the open abdomen::

(1) greater acidosis (more negative base excess) on arrival

(2) penetrating trauma

(3) higher Penetrating Abdominal Trauma Index (PATI)

(4) lower ISS



• The odds ratio for lower ISS was 0.94 which is not very large. The authors noted that the ISS tends to be underestimated with penetrating injuries.

• The base excess range for closure was –12 to –4 (mean –8) and for failure was –16 to –6 (mean –11). Cutoffs for the implementation were chosen as >= -7 and <= -10.

• The PATI ranged from 11 to 39 (mean 25) for primary closure and 10 to 50 (mean 30) in those with failed closure. Cutoffs for the implementation were chosen at <= 20 and >= 30.


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