title: Selective non-operative management of abdominal gunshot wounds: survey of practise.
abstract: BACKGROUND
  There is a growing body of evidence attesting to the effectiveness and safety of selective non-operative management (SNOM) of abdominal gunshot wounds. However, much of the research which supports this conclusion has originated from a few centres, and the actual utilisation of SNOM by trauma surgeons is not known. We therefore conducted a survey to assess the acceptance of this strategy and evaluate variations in practise.
  
  
  METHODS
  Electronic questionnaire survey of trauma surgeons in the United States of America, Canada, Brazil, and South Africa. Responses were compared using Chi(2) and Fisher's exact tests.
  
  
  RESULTS
  183 replies were received. 105 (57%) respondents practise SNOM of abdominal gunshot wounds, but there are marked regional variations in the acceptance of this strategy (p<0.01). Respondents who had completed trauma (p<0.01) or critical care (p<0.01) fellowships, and those who practise in a higher volume centre (defined as >50 penetrating abdominal injuries seen per year) (p<0.01) are more likely to practise SNOM of gunshot wounds. Most surgeons who practise SNOM regard peritonitis, omental and bowel evisceration, and being unable to evaluate a patient as a contraindication to attempting non-operative management. Almost all regard CT as essential. Respondents' preparedness to consider SNOM is related to injury extent.
  
  
  CONCLUSIONS
  SNOM of abdominal gunshot wounds is practised by trauma surgeons in all four countries surveyed, but is not universally accepted, and there are variations in how it is practised.
authors.affiliation: Department of Surgery and Department of Intensive Care Medicine, University of Aberdeen, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK. j.o.jansen@gmx.com
authors.forename: Jan O
authors.initials: JO
authors.lastname: Jansen
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Shelby
authors.initials: S
authors.lastname: Resnick
authors.forename: Gustavo P
authors.initials: GP
authors.lastname: Fraga
authors.forename: Sizenando V
authors.initials: SV
authors.lastname: Starling
authors.forename: Sandro B
authors.initials: SB
authors.lastname: Rizoli
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Boffard
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D000328:Adult; D001938:Brazil / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D005260:Female; D006439:Hemodynamics; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009852:Omentum / Q000293:injuries*; D018579:Patient Selection; D010538:Peritonitis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011859:Radiography; D013019:South Africa / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*