title: Negative laparotomy in trauma: are we getting better?
abstract: One of the trauma surgeons' daily challenges is the balancing act between negative laparotomy and missed abdominal injury. We opted to characterize the indications that prompted a negative trauma exploratory laparotomy and the rate of missed abdominal injuries in an effort to  optimize patient selection for laparotomy. At the Los Angeles County + University of Southern California Medical Center, negative laparotomies and missed injuries are consecutively captured and reviewed at the weekly mortality + morbidity (MM) conferences. All written reports of the MM meetings  from January 2003 to December 2008 were reviewed to identify all patients who underwent a negative laparotomy or a laparotomy as a result of an initially missed abdominal injury. Over the 6-year study period, a total of 1871 laparotomies were performed, of which 73 (3.9%) were negative. The  rate of missed injuries requiring subsequent laparotomy was 1.3 per cent (25 of 1871). The negative laparotomy rate and the rate of missed injuries did not vary significantly during the study period (2.8 to 4.7%, P = 0.875, and 0.7 to 2.9%, P = 0.689). Penetrating mechanisms  accounted for the majority of negative laparotomies (58.9%). The primary indication for negative laparotomy was peritonitis (54.8%) followed by hypotension (28.8%) and suspicious computed tomographic scan findings (27.4%). The complication rate after negative laparotomy was 14.5 per cent,  and of these, 10.1 per cent were directly related to the procedure. A low but steady rate of negative laparotomies and missed abdominal injuries after trauma remains. Negative laparotomies and missed abdominal injuries when they occur are still associated with significant complication rates  and a prolonged length of stay.
authors.affiliation: Division of Acute Care Surgery, University of Southern California, LAC1USC Medical Center, Los Angeles, California, USA.
authors.forename: Beat
authors.initials: B
authors.lastname: Schnüriger
authors.forename: Lydia
authors.initials: L
authors.lastname: Lam
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Leslie
authors.initials: L
authors.lastname: Kobayashi
authors.forename: Raffaella
authors.initials: R
authors.lastname: Barbarino
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis*; D000328:Adult; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D012189:Retrospective Studies