Stab wounds to the back and flank in the hemodynamically stable patient: a decision algorithm based on contrast-enhanced computed tomography with colonic opacification.
OBJECTIVE
The authors wanted to determine whether contrast-enhanced computed tomography (CE-CT) with colonic opacification is an accurate tool to triage hemodynamically stable victims of stab wounds to the flank and back.


METHODS
One hundred forty-five consecutive patients were categorized as low-risk ( penetration superficial to the deep fascia) or high-risk (penetration beyond the deep fascia) based on CE-CT findings.


RESULTS
There were no significant differences in admission vital signs, Glasgow Coma Scale, or complete blood counts between low- and high-risk groups. None of the 92 low-risk patients required surgery or had sequelae. Six of the 53 high-risk patients underwent surgery, 2 based on initial CE-CT, 4 due to evolving clinical signs. The CE-CT correctly predicted surgical findings in all cases.


CONCLUSIONS
Hemodynamically stable patients with stab wounds to the back and/or flank can be successfully triaged based on CE-CT findings. Low-risk patients may be discharged immediately. High-risk patients may have a discharge decision implemented at 24 hours.
Kirton
O C
OC
Department of Surgery, Division of Trauma University of Miami/Jackson Memorial Medical Center, Florida 33101, USA.
Wint
D
D
Thrasher
B
B
Windsor
J
J
Echenique
A
A
Hudson-Civetta
J
J
D000007:Abdominal Injuries / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D019567:Back Injuries; D003106:Colon / Q000000981:diagnostic imaging*; D003287:Contrast Media; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D012189:Retrospective Studies; D012307:Risk Factors; D013898:Thoracic Injuries / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014218:Triage; D014951:Wounds, Stab / Q000000981:diagnostic imaging* / Q000503:physiopathology
D003287:Contrast Media