title: Selective nonoperative management in 1106 patients with abdominal gunshot wounds: conclusions on safety, efficacy, and the role of selective CT imaging in a prospective single-center study.
abstract: OBJECTIVE
  The primary aim of this study was to delineate the role of computed tomography (CT) in patients undergoing NOM for AGSW.
  
  
  BACKGROUND
  Nonoperative management (NOM) of abdominal gunshot wounds (AGSWs) remains controversial.
  
  
  METHODS
  This prospective study included all patients with abdominal gunshot injuries admitted to our trauma center from April 1, 2004 to September 30, 2009. Exclusion criteria included patients with peritonitis, hemodynamic instability, unreliable physical examination, head and spinal cord injury with an AGSW underwent immediate laparotomy. The remaining patients were selected for NOM. Nonperitonitic stable patients with right-sided thoracoabdominal/right upper quadrant gunshots and/or hematuria underwent mandatory CT with intravenous contrast. CT to detect missile trajectory was optional. The primary outcome measure was failure of NOM. Secondary outcomes were unnecessary laparotomy rates and mortality.
  
  
  RESULTS
  A total of 1106 patients with abdominal gunshot injuries were admitted. Of these, 834 (75.4%) underwent immediate laparotomy, whereas 272 (24.6%) were selected for NOM. In the former group, there were 56 (6.7%) deaths and 29 (3.5%) unnecessary laparotomies, whereas in the latter NOM group, 82 (30.1%) patients were managed by serial clinical examination alone, whereas 190 (69.9%) patients underwent abdominal CT scanning, in addition to serial clinical examination. The overall NOM success rate was 95.2%. Of the 13 patients undergoing delayed laparotomy, there were 10 therapeutic, 2 nontherapeutic, and 1 negative laparotomy.
  
  
  CONCLUSIONS
  The NOM of appropriately selected patients with AGSW with selective use of CT scanning is feasible, safe, and effective, but largely based on findings from serial clinical examinations.
authors.affiliation: *Trauma Center, Groote Schuur Hospital, and Faculty of Health Sciences, University of Cape Town and Medical Research Council of South Africa, Cape Town, South Africa †Department of Surgery, University of Calgary, Calgary, Canada.
authors.forename: Pradeep H
authors.initials: PH
authors.lastname: Navsaria
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Nicol
authors.forename: Sorin
authors.initials: S
authors.lastname: Edu
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gandhi
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007668:Kidney / Q000000981:diagnostic imaging / Q000293:injuries; D007813:Laparotomy / Q000706:statistics & numerical data; D007902:Length of Stay; D008099:Liver / Q000000981:diagnostic imaging / Q000293:injuries; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging / Q000293:injuries; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000293:injuries; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D055815:Young Adult