Abstract
Purpose
As an increasing amount of penetrating abdominal stab injuries has been observed in the last few decades, it is important to evaluate the adequacy of the medical systems and surgical education and training to handle this type of injury. The aim of this study was to analyze the outcome of patients with penetrating abdominal stab injuries admitted to the Emergency Unit and to evaluate the effects of using a new treatment algorithm.
Methods
From January 2009 to April 2009, a standardized education and training system for the surgical team was implemented in order to improve the emergency medical care system. From April 2009 to April 2011, 106 patients with the diagnosis of a penetrating abdominal stab injury were prospectively included in the study.
Results
The cohort included 98 males and the mean age was 29.40 ± 10.9 years. Eighty-two percent of the patients were managed conservatively, whereas 18 % underwent surgery. Based on the surgical outcomes of the patients, the rate of negative, non-therapeutic, and therapeutic laparotomies was 5, 11, and 84 %, respectively. No statistically significant difference between patients who did and did not receive surgery was observed with regards to blood pressure, temperature, hematocrit, hemoglobin, and C-reactive protein (CRP) values. However, a statistically significant difference was observed in the pulse rate, leukocyte, and neutrophil counts. The mortality and morbidity rates were 0.94 and 3.77 %, respectively.
Conclusions
Selective non-operative management, which has been standardized in trauma centers, may be carefully utilized in order to treat penetrating abdominal stab wounds with caution in well-equipped medical centers with well-trained staff.
Similar content being viewed by others
References
Schreyer N, Carron PN, Demartines N, Yersin B. Stab wounds in a Swiss emergency department: a series of 80 consecutive cases. Swiss Med Wkly. 2010;140:w130582.
Jansen JO, Inaba K, Rizoli SB, Boffard KD, Demetriades D. Selective non-operative management of penetrating abdominal injury in Great Britain and Ireland: survey of practice. Injury. 2011. doi:10.1016/j.injury.2011.03.062.
Demetriades D, Rabinowitz B. Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Ann Surg. 1987;205:129–32.
Fabian TC, Croce MA, Stewart RM, Pritchard FE, Minard G, Kudsk KA. A prospective analysis of diagnostic laparoscopy in trauma. Ann Surg. 1993;217(5):557–64.
Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, Ivatury RR, Scalea TM. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma. 2010;68:721–33.
Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, Salim A. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg. 2006;244:620–8.
Yucel M, Caliskan M, Ozpek A, Subasi IE, Sisik A, Erdem H, Tekesin K, Akinci OF, Alimoglu O. Assessing of selective management of penetrating abdominal stab injury. J Vakıf Gureba. 2009;7:36–40.
American College of Surgeons. Advanced trauma life support, Chicago, 1997.
Moore FA, Davis JW, Moore EE Jr, Cocanour CS, West MA, McIntyre RC Jr. Western Trauma Association (WTA) critical decisions in trauma: management of adult blunt splenic trauma. J Trauma. 2008;65:1007–11.
Shaftan GW. Indications for operation in abdominal trauma. Am J Surg. 1960;99:657–64.
Kopelman TR, O’Neill PJ, Macias LH, Cox JC, Matthews MR, Drachman DA. The utility of diagnostic laparoscopy in the evaluation of anterior abdominal stab wounds. Am J Surg. 2008;196:871–7.
Ertekin C, Yanar H, Taviloğlu K, Güloglu R, Alimoglu O. Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds. Emerg Med J. 2005;22:790–4.
Nagy K, Roberts R, Joseph K, An G, Barrett J. Evisceration after abdominal stab wounds: is laparotomy required? J Trauma. 1999;47:622–6.
da Silva M, Navsaria PH, Edu S, Nicol AJ. Evisceration following abdominal stab wounds: analysis of 66 cases. World J Surg. 2009;33:215–9.
Arikan S, Kocakusak A, Yucel AF, Adas G. A prospective comparison of the selective observation and routine exploration methods for penetrating abdominal stab wounds with organ or omentum evisceration. J Trauma. 2005;58:526–32.
Powell BS, Magnotti LJ, Schroeppel TJ, Finnell CW, Savage SA, Fischer PE, Fabian TC, Croce MA. Diagnostic laparoscopy for the evaluation of occult diaphragmatic injury following penetrating thoracoabdominal trauma. Injury. 2008;39:530–4.
Murray JA, Demetriades D, Cornwell EE 3rd, Asensio JA, Velmahos G, Belzberg H, Berne TV. Penetrating left thoracoabdominal trauma: the incidence and clinical presentation of diaphragm injuries. J Trauma. 1997;43:624–6.
Ertekin C, Onaran Y, Güloğlu R, Günay K, Taviloğlu K. The use of laparoscopy as a primary diagnostic and therapeutic method in penetrating wounds of lower thoracal region. Surg Laparosc Endosc. 1998;8:26–9.
Renz BM, Feliciano DV. Unnecessary laparotomies for trauma: a prospective study of morbidity. J Trauma. 1995;38:350–6.
Alimoglu O. Laparoscopy in penetrating abdominal trauma. Eur Surg. 2005;37:28–32.
Conflict of interest
None declared.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Alimoglu, O., Yucel, M., Subasi, I.E. et al. Evolution-based algorithm for the management of penetrating abdominal stab injury. Eur J Trauma Emerg Surg 38, 531–536 (2012). https://doi.org/10.1007/s00068-012-0188-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00068-012-0188-8