Selective clinical management of anterior abdominal stab wounds.
BACKGROUND
The optimal management of clinically stable patients with anterior abdominal stab wounds (AASWs) is debated. We implemented a protocol of serial clinical assessments to determine the need for laparotomy. The purpose of this study was to determine whether the approach is safe and effective.


METHODS
Records of patients sustaining AASWs from 1999 to 2003 were reviewed.


RESULTS
Seventy-seven patients sustained AASWs. Twenty-five were taken directly to the operating room because of hypotension (5), evisceration (7), or peritonitis (15). Seventeen patients had diagnostic peritoneal lavage (DPL) for associated thoracoabdominal wounds and 5 had local wound exploration (LWE) off protocol. The remaining 30 patients were managed with serial clinical assessments and were discharged uneventfully.


CONCLUSIONS
Patients sustaining AASWs who present without hypotension, evisceration, or peritonitis may be managed safely under a protocol of serial clinical evaluations. This approach should be compared with LWE/DPL in a prospective, randomized multicenter trial.
Tsikitis
Vassiliki
V
Division of Trauma and Surgical Critical Care, Rhode Island Hospital/Brown Medical School, 593 Eddy Street, APC 443, Providence, RI 02903, USA.
Biffl
Walter L
WL
Majercik
Sarah
S
Harrington
David T
DT
Cioffi
William G
WG
D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006301:Health Services Needs and Demand; D006465:Hemoperitoneum / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D010535:Laparoscopy / Q000379:methods; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010533:Peritoneal Lavage; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome; D014951:Wounds, Stab / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*