title: Selective nonoperative management of anterior abdominal stab wounds: 1992-2008.
abstract: BACKGROUND
  The use of selective nonoperative management for anterior abdominal stab wounds has evolved into a readily accepted practice. Multiple reports have shown this strategy to be both safe and effective. However, there is a paucity of long-term studies.
  
  
  METHODS
  A retrospective review was performed of all trauma patients presenting for anterior abdominal stab wounds at a Level I trauma center during a 17-year time period. Primary outcomes were the percentage of patients undergoing an exploratory laparotomy and the negative laparotomy rate.
  
  
  RESULTS
  A total of 7,033 patients sustained a stab wound with 1,961 involving the anterior abdomen. The percentage of patients undergoing exploratory laparotomy decreased during the study period from 64.8% to 37.6% (overall 45.8%). The negative laparotomy rate decreased from 21.3% to 8.6% (overall 18.7%). The negative laparotomy rate of patients who underwent exploratory laparotomy immediately did not change over time (13.8%), whereas the negative laparotomy rate of those patients who underwent exploratory laparotomy in a delayed fashion decreased from 25.0% to 6.25%. The overall mortality was 1.9%, with 6.2% mortality for patients undergoing an immediate laparotomy, 0.7% for patients undergoing a delayed laparotomy, and 0.0% for patients managed nonoperatively (p<0.04). The mean length of hospital stay was 6.6 days±0.5 days, with a mean of 9.4 days±0.9 days in patients undergoing an immediate laparotomy, 8.1 days±0.5 days in patients undergo a delayed laparotomy, and 3.8 days±0.2 days in patients managed nonoperatively (p<0.001).
  
  
  CONCLUSIONS
  Selective nonoperative management for stab wounds to the anterior abdomen is associated with a decreased operative rate and decreased negative laparotomy rate over time. Selective nonoperative management is both safe and effective for anterior abdominal stab wounds.
authors.affiliation: Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Plackett
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fleurat
authors.forename: Brad
authors.initials: B
authors.lastname: Putty
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
authors.forename: David
authors.initials: D
authors.lastname: Plurad
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014951:Wounds, Stab / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy