When is it safe to discharge asymptomatic patients with abdominal stab wounds?
BACKGROUND
This study sought to determine the time from hospital presentation to surgical intervention for hemodynamically stable patients with abdominal stab wounds. The objective was to identify the optimal time for observation of these asymptomatic patients before safe hospital discharge.


METHODS
The authors reviewed a prospectively collected trauma database at their level 1 trauma center. The time from admission to surgery was noted in their patient population. All stab wound patients who underwent either peritoneal lavage or immediate surgery were excluded from the study.


RESULTS
During a 7-year period, 650 asymptomatic patients with abdominal stab wounds were admitted for serial examination. The study showed that 567 of these patients had no abdominal surgical intervention, whereas 68 underwent abdominal surgery (15 left the center against medical advice). No patients were identified as requiring surgery more than 12 hours after presentation.


CONCLUSIONS
It appears that asymptomatic patients with abdominal stab wounds may be discharged from the hospital after 12 hours of observation with little likelihood of missed injury.
Alzamel
Heythem A
HA
Division of Trauma, University of Miami School of Medicine, Miami, Florida, USA.
Cohn
Stephen M
SM
D000007:Abdominal Injuries / Q000175:diagnosis / Q000628:therapy*; D000465:Algorithms; D003663:Decision Trees; D005260:Female; D005431:Florida; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D010351:Patient Discharge / Q000592:standards*; D018579:Patient Selection; D010533:Peritoneal Lavage; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D012189:Retrospective Studies; D012449:Safety; D013997:Time Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D014951:Wounds, Stab / Q000150:complications / Q000175:diagnosis / Q000628:therapy*