Negative trauma celiotomy.
A retrospective review of 525 consecutive exploratory celiotomies for abdominal trauma occurring between January 1987 and June 1990 in an urban trauma center was conducted. One hundred-fifteen patients sustained blunt abdominal trauma (21%), and 410 patients sustained penetrating abdominal trauma (78%). Penetrating injuries included 260 gunshot wounds and 150 stab wounds. Patients were divided into three groups: Group A (16%), no visceral injuries identified at exploration (true negative); Group B, positive operative findings at celiotomy requiring no operative repair (10%) (nontherapeutic celiotomy); and Group C (74%), injuries encountered requiring operative repair (true positive). A positive exploration rate of 90 per cent with blunt trauma is acceptable using diagnostic techniques currently available. Similarly, a positive exploration rate of 85 per cent in gunshot wounds warrants our continued use of mandatory celiotomy. A 36 per cent combined incidence of true negatives and nontherapeutic celiotomies (Group A and B) is unacceptably high. To reduce this high incidence will require improved clinical surveillance and the controlled implementation of newer diagnostic techniques.
Department of Surgery, University of California, Davis-East Bay 94602.
V J
VJ
Henderson
C H
CH
Organ
R S
RS
Smith
D000005:Abdomen / Q000601:surgery*; D000007:Abdominal Injuries / Q000175:diagnosis* / Q000601:surgery; D002140:California / Q000453:epidemiology; D003949:Diagnostic Techniques, Surgical; D005260:Female; D006801:Humans; D015994:Incidence; D007813:Laparotomy / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D010537:Peritoneum / Q000293:injuries / Q000473:pathology; D011183:Postoperative Complications; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014948:Wounds, Gunshot / Q000175:diagnosis / Q000601:surgery; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000601:surgery; D014951:Wounds, Stab / Q000175:diagnosis / Q000601:surgery