Trauma Surgery Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped trauma surgery practice.

Damage Control Surgery

When less is more — acutely

Definitive always → Rotondo damage control (1993) → triad recognition → DCR → refined

Blood products first

Crystalloid-first → 1:1:1 → PROPPR (2015) → whole blood → viscoelastic-guided (TEG/ROTEM)

A cheap drug saves lives

No antifibrinolytic → CRASH-2 (2010) → WOMAN → time-dependent (within 3h) → prehospital

Observation replaces the knife

Operate-all → selective NOM spleen → liver NOM → AAST grading → angioembolization → guidelines

Less fluid, less bleeding

Aggressive crystalloid → Bickell (1994) → target SBP 80-90 → penetrating vs blunt → DCR