Use of computed tomography in anterior abdominal stab wounds: results of a prospective study.
OBJECTIVE
Computed tomography (CT) can be used to evaluate patients with anterior abdominal stab wounds (AASWs).


METHODS
Prospective observational study.


METHODS
Academic level I trauma center.


METHODS
All of the patients sustaining AASWs, excluding those with hemodynamic instability, peritonitis, or omental evisceration, were admitted for serial abdominal examinations with or without CT depending on attending preference. Patients with associated left thoracoabdominal stab wounds underwent diagnostic laparoscopy.


METHODS
Change in patient management as a direct result of the CT scan findings, as well as sensitivity, specificity, positive predictive value, and negative predictive value of CT scanning calculated against clinical outcome (the need for laparotomy, uneventful discharge without laparotomy, or return to the hospital for adverse events).


RESULTS
One hundred fifty-six consecutive patients with AASWs were included over 24 months. Computed tomography was performed for 67 patients (CT group) whereas 89 patients were admitted for serial examination only (no-CT group). Nineteen of the 67 patients in the CT group had positive CT results, leading to laparotomy in 10 patients. Of the 48 patients with negative CT results, 3 underwent diagnostic laparoscopy for an associated thoracoabdominal stab wound and 2 eventually underwent laparotomy for clinical deterioration with negative results. Excluding patients with associated thoracoabdominal stab wounds, the negative predictive value of CT was 100%.


CONCLUSIONS
In patients with AASWs, CT can be used to identify visceral injuries. It is a promising tool that may identify patients who can be discharged after a shorter period of observation. Further evaluation of its use in patients with AASWs is warranted.
Salim
Ali
A
Division of Trauma and Critical Care, Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles, USA. asalim@surgery.usc.edu
Sangthong
Burapat
B
Martin
Matthew
M
Brown
Carlos
C
Plurad
David
D
Inaba
Kenji
K
Rhee
Peter
P
Demetriades
Demetrios
D
D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D015599:Trauma Severity Indices; D014951:Wounds, Stab / Q000000981:diagnostic imaging* / Q000601:surgery