title: What is the optimal observation time for a penetrating wound to the flank?
abstract: Options for a hemodynamically stable patient with a penetrating wound to the flank or back but no peritonitis, includes serial physical examinations versus a triple-contrast CT scan. There is, however, little consensus on the minimum time for serial examinations to exclude an injury that requires an operation. Therefore, a retrospective review of patients who sustained a penetrating wound to the flank or back and were admitted to a Level I trauma center was performed. Patients were identified through the trauma registry, patient charts, and morbidity/mortality records. From 1995 to 2003, 93 patients undergoing observation for a penetrating flank/back wound subsequently required a therapeutic laparotomy. The time from admission to operation was less than 3 hours for 84 per cent of the patients requiring therapeutic intervention. A further 10 per cent presented with symptoms between 4 to 6 hours, and 6 per cent between 7 to 18 hours. All the injuries caused symptoms within 18 hours of the injury event. The majority of patients (94%) who require a laparotomy after a period of observation for a penetrating flank/back wound will develop signs and symptoms within 6 hours of admission. A period of hospitalization longer than 18 hours did not detect further injuries in the asymptomatic patient.
authors.affiliation: Department of Surgery, Emory University, School of Medicine, Atlanta, Georgia, USA.
authors.forename: Jana
authors.initials: J
authors.lastname: MacLeod
authors.forename: Doug
authors.initials: D
authors.lastname: Freiberger
authors.forename: Fran
authors.initials: F
authors.lastname: Lewis
authors.forename: David
authors.initials: D
authors.lastname: Feliciano
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000601:surgery; D000328:Adult; D019567:Back Injuries / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D011379:Prognosis; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging / Q000293:injuries; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D015599:Trauma Severity Indices; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000601:surgery