title: [A study of the predictive value of the primary review and complementary examinations in assessing the need for surgery in patients with stab wounds in the torso].
abstract: BACKGROUND
  Observation is the gold standard for stable patients with stab wounds. The aim of the study was to analyse the value of the primary review and complementary examinations to predict the need for surgery in stab wound patients in order to decrease observation times.
  
  
  METHODS
  A retrospective study of stab wound patients recorded in a database. Clinical and diagnostic workup parameters were analysed. The main variable was the need for surgery.
  
  
  RESULTS
  A total of 198 patients were included between 2006 and 2009, with a mean injury severity score (ISS) of 7.8±7, and 0.5% mortality. More than half (52%) of the patients suffered multiple wounds. Wound distribution was 23% neck, 46% thorax and 31% abdomen. Surgery was required in 73 (37%) patients (59% immediate, 27% delayed and 14% delayed). The need for surgery was associated with a lower revised trauma score (RTS), evisceration, active bleeding, and fascial penetration. Initial and control haemoglobin levels were significantly lower in patients who required surgery. A positive computerised tomography (CT) scan was associated with surgery. There were complications in 18% of patients, and they were more frequent in those who underwent surgery. There was no difference in complication rates between immediate and delayed (P=.72). Surgery was finally required in 10% of the patients with no abnormalities in the primary review and diagnostic workup, and 6% of those developed complications.
  
  
  CONCLUSIONS
  None of the parameters studied could individually assess the need for surgery. Primary and secondary reviews were the most important diagnostic tool, but CT scan should be used more often. An observation period of 24 hours is recommended in torso penetrating wounds.
authors.affiliation: Unidad de Urgencias Quirúrgicas y Politrauma, Servicio de Cirugía General y Digestiva, Hospital Universitari del Mar, Barcelona, España. isidromartinez@me.com
authors.forename: Isidro
authors.initials: I
authors.lastname: Martínez Casas
authors.forename: Joan
authors.initials: J
authors.lastname: Sancho Insenser
authors.forename: Marta
authors.initials: M
authors.lastname: Climent Agustín
authors.forename: Estela
authors.initials: E
authors.lastname: Membrilla Fernández
authors.forename: María José
authors.initials: MJ
authors.lastname: Pons Fragero
authors.forename: Juan
authors.initials: J
authors.lastname: Guzmán Ahumada
authors.forename: Luis
authors.initials: L
authors.lastname: Grande Posa
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010808:Physical Examination; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D060726:Torso / Q000293:injuries* / Q000601:surgery*; D014951:Wounds, Stab / Q000175:diagnosis* / Q000601:surgery*