title: Prediction of injury caused by penetrating wounds to the abdomen, flank, and back.
abstract: Controversy about the appropriate evaluation of penetrating abdominal, flank, and back injuries prompted this retrospective review of 311 patients at an urban level 1 trauma center over 5 years. Seventy-five (24%) patients sustained gunshot wounds to the abdomen. All patients with gunshot wounds underwent exploratory laparotomy; results of 67 laparotomies (89%) were positive. Of 236 patients sustaining stab wounds (140 abdominal wounds, 51 flank wounds, 26 back wounds, and 19 wounds to multiple sites), 147 were treated according to a selective protocol, based on results of physical examination, wound exploration, peritoneal lavage, and ancillary diagnostic studies. No injuries were found at celiotomy in three (2%) of these 147 patients. One false-negative result of evaluation of a flank wound occurred. Significant injuries were found in 13 patients (68%) with stab wounds to multiple sites, 61 patients (44%) with abdominal stab wounds, 15 patients (29%) with flank stab wounds, and four patients (15%) with back stab wounds. Mandatory exploration of gunshot wounds is justified. Physical findings of intra-abdominal injury or positive results of peritoneal lavage identify stab wound victims likely to benefit from surgical exploration. A policy of mandatory observation or routine celiotomy for treatment of stab wounds is not justified.
authors.affiliation: Indiana University Regional Trauma Center, Indianapolis.
authors.forename: M C
authors.initials: MC
authors.lastname: McCarthy
authors.forename: G A
authors.initials: GA
authors.lastname: Lowdermilk
authors.forename: D F
authors.initials: DF
authors.lastname: Canal
authors.forename: T A
authors.initials: TA
authors.lastname: Broadie
mesh_terms: D000005:Abdomen / Q000601:surgery; D000007:Abdominal Injuries / Q000601:surgery* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D001415:Back / Q000601:surgery; D019567:Back Injuries; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery; D010533:Peritoneal Lavage; D010537:Peritoneum / Q000293:injuries / Q000601:surgery; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013898:Thoracic Injuries / Q000601:surgery* / Q000628:therapy; D014948:Wounds, Gunshot / Q000601:surgery / Q000628:therapy; D014950:Wounds, Penetrating / Q000601:surgery* / Q000628:therapy; D014951:Wounds, Stab / Q000601:surgery / Q000628:therapy