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Management of haemodynamically stable patients with penetrating abdominal stab injuries: review of practice at an Australian major trauma centre

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Introduction

The management of haemodynamically stable patients who present following a penetrating abdominal injury (PAI) remains variable between mandatory surgical exploration and more selective non-operative approaches. The primary aim of this study was to assess compliance with an algorithm guiding selective non-operative management of haemodynamically stable patients with PAI. The secondary aim was to examine the association between compliance and unnecessary laparotomies.

Methods

This was a retrospective cohort study involving all patients with PAI that presented to a major trauma centre from January 2007 to December 2011. Data were extracted from the trauma registry and patients’ electronic medical records.

Results

There were 189 patients included in the study, of which 79 (41.8 %) patients complied with the algorithm. The laparotomy rate in the setting of algorithm compliance was significantly lower than algorithm non-compliance (12.7 vs. 68.2 %; p < 0.01) as were unnecessary laparotomy rates (0 vs. 33.3 %; p = 0.03).

Conclusion

Among haemodynamically stable patients presenting with PAI, compliance with an algorithm guiding selective non-operative management was low, but associated with lower laparotomy and lower unnecessary laparotomy rates. Improved compliance with algorithms directed towards selective non-operative management of PAI should be encouraged with stringent vigilance towards patient safety.

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Abbreviations

PAI:

Penetrating abdominal injury

ED:

Emergency department

SNOM:

Selective non-operative management

MTS:

Major trauma services

ISS:

Injury severity score

ICU:

Intensive care unit

FAST:

Focused assessment with sonography for trauma

OT:

Operating theatre

CT:

Computed tomography

SBP:

Systolic blood pressure

HR:

Heart rate

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Acknowledgments

We would like to thank the staff at the Medical Records department of The Alfred Hospital for making patient histories available for review.

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Authors and Affiliations

  1. Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia

    J. Kevric, G. M. O’Reilly, R. A. Gocentas, O. Hasip, C. Pilgrim & B. Mitra

  2. Emergency & Trauma Centre, The Alfred Hospital, Commercial Rd., Melbourne, VIC, 3004, Australia

    J. Kevric, G. M. O’Reilly, R. A. Gocentas, O. Hasip, C. Pilgrim & B. Mitra

  3. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    J. Kevric, G. M. O’Reilly, R. A. Gocentas, O. Hasip, C. Pilgrim & B. Mitra

  4. National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia

    J. Kevric, G. M. O’Reilly, R. A. Gocentas, O. Hasip, C. Pilgrim & B. Mitra

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  1. J. Kevric
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  2. G. M. O’Reilly
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  3. R. A. Gocentas
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  4. O. Hasip
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  5. C. Pilgrim
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  6. B. Mitra
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Corresponding author

Correspondence to J. Kevric.

Ethics declarations

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Specific national laws have been observed.

Conflict of interest

Jasmina Kevric, Gerard O’Reilly, Robert Gocentas, Orcun Hasip, Charles Pilgrim and Biswadev Mitra have no conflict of interest or financial support to declare.

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Kevric, J., O’Reilly, G.M., Gocentas, R.A. et al. Management of haemodynamically stable patients with penetrating abdominal stab injuries: review of practice at an Australian major trauma centre. Eur J Trauma Emerg Surg 42, 671–675 (2016). https://doi.org/10.1007/s00068-015-0605-x

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  • DOI: https://doi.org/10.1007/s00068-015-0605-x

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