title: The utility of laparoscopic evaluation of the parietal peritoneum in the management of anterior abdominal stab wounds.
abstract: BACKGROUND
  Trauma centres vary in their approaches to managing stable patients with anterior abdominal stab wounds (AASWs), with no approach yet proven superior. We sought to evaluate the performance of screening laparoscopy (i.e., parietal peritoneal penetration or not) in determining which patients should undergo laparotomy.
  
  
  METHODS
  We conducted a retrospective case series study, including all patients with an AASW who presented to U.C. Davis Medical Center from January 2003 through March 2009. We collected data from medical records using a standardised, pre-tested instrument. Among laparoscopically screened cases, we determined the test characteristics of peritoneal penetration for detecting intra-abdominal injury. We sub-classified injuries as "requiring treatment" (e.g., full-thickness enterotomy or active haemorrhage) or not.
  
  
  RESULTS
  Of 358 patients with AASWs, 163 underwent screening laparoscopy. Seventy-eight of the 163 (48%) had no peritoneal penetration and six (4%) had peritoneal penetration but a low-risk wound; none of these 84 underwent laparotomy nor had a missed injury. Of 79 patients with peritoneal penetration who underwent laparotomy, 61 had an intra-abdominal injury, of whom 42 were treated intraoperatively. Among these 42, 30 had an injury "requiring treatment." The PPV of peritoneal penetration for an injury requiring treatment was 38% (30/79) (95% CI 27-50%), NPV 100% (84/84) (95% CI 95-100%), sensitivity 100% (30/30) (95% CI 88-100%), and specificity 63% (84/133) (95% CI 54-71%). The negative and positive likelihood ratios were 0 (95% CI 0-0.4) and 2.7 (95% CI 2.2-3.4), respectively.
  
  
  CONCLUSIONS
  Screening laparoscopic evaluation of the parietal peritoneum results in a negligible rate of missed injury and an approximately 40% rate of finding an injury requiring treatment.
authors.affiliation: Department of Surgery, University of California, Davis, Medical Center, Sacramento, CA, United States.
authors.forename: Mona
authors.initials: M
authors.lastname: Shah
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Galante
authors.forename: Lynette A
authors.initials: LA
authors.lastname: Scherer
authors.forename: Garth H
authors.initials: GH
authors.lastname: Utter
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D000328:Adult; D000465:Algorithms; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D010535:Laparoscopy / Q000706:statistics & numerical data*; D007813:Laparotomy; D007902:Length of Stay; D008297:Male; D018579:Patient Selection; D010533:Peritoneal Lavage / Q000379:methods; D010537:Peritoneum / Q000293:injuries / Q000473:pathology*; D010538:Peritonitis / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D014193:Trauma Centers; D014951:Wounds, Stab / Q000150:complications / Q000401:mortality / Q000473:pathology*
keywords: Algorithm; Anterior abdomen; Penetrating abdominal trauma; Peritoneal penetration; Screening laparoscopy; Stab wound