title: Feasibility of selective non-operative management for penetrating abdominal trauma in France.
abstract: BACKGROUND
  In France, non-operative management (NOM) is not the widely accepted treatment for penetrating wounds. The aim of our study was to evaluate the feasibility of NOM for the treatment of penetrating abdominal traumas at 3 hospitals in the Southeast of France.
  
  
  METHODS
  Our study was multicentric and retroprospective from January, 2010 to September, 2013. Patients presenting with a penetrating abdominal stab wound (SW) or gunshot wound (GSW) were included in the study. Those with signs of acute abdomen or hemodynamic instability had immediate surgery. Patients who were hemodynamically stable had a CT scan with contrast. If no intra-abdominal injury requiring surgery was evident, patients were observed. Criteria evaluated were failed NOM and its morbidity, rate of non-therapeutic procedures (NTP) and their morbidity, length of hospital stay and cost analysis.
  
  
  RESULTS
  One hundred patients were included in the study. One patient died at admission. Twenty-seven were selected for NOM (20 SW and 7 GSW). Morbidity rate was 18%. Failure rate was 7.4% (2 patients) and there were no mortality. Seventy-two patients required operation of which 22 were NTP. In this sub-group, the morbidity rate was 9%. There were no mortality. Median length of hospital stay was 4 days for the NOM group and 5.5 days for group requiring surgery. Cost analysis showed an economic advantage to NOM.
  
  
  CONCLUSIONS
  Implementation of NOM of penetrating trauma is feasible and safe in France. Indications may be extended even for some GSW. Clinical criteria are clearly defined but CT scan criteria should be better described to improve patient selection. NOM reduced costs and length of hospital stay.
authors.affiliation: Department of General and Thoracic Surgery, Laveran Military medical Center, HIA Laveran, 34, boulevard Laveran, CS 50004, 13384 Marseille cedex13, France. Electronic address: goingeraldine@yahoo.fr.
authors.forename: G
authors.initials: G
authors.lastname: Goin
authors.affiliation: Department of general surgery, pôle urgences, Universitary Hospital Saint-Roch, Sophia Antipolis University, Nice, France. Electronic address: massalou.d@chu-nice.fr.
authors.forename: D
authors.initials: D
authors.lastname: Massalou
authors.affiliation: Department of General surgery, Universitary Hospital Nord, Marseille, France. Electronic address: thierry.bege@ap-hm.fr.
authors.forename: T
authors.initials: T
authors.lastname: Bege
authors.affiliation: ICU Department, Laveran Military medical Center, Marseille, France. Electronic address: contargyris@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Contargyris
authors.affiliation: Department of General and Thoracic Surgery, Laveran Military medical Center, HIA Laveran, 34, boulevard Laveran, CS 50004, 13384 Marseille cedex13, France. Electronic address: avarojp@orange.fr.
authors.forename: J-P
authors.initials: JP
authors.lastname: Avaro
authors.affiliation: Department of General and Thoracic Surgery, Laveran Military medical Center, HIA Laveran, 34, boulevard Laveran, CS 50004, 13384 Marseille cedex13, France. Electronic address: ghislainpauleau@yahoo.fr.
authors.forename: G
authors.initials: G
authors.lastname: Pauleau
authors.affiliation: Department of General and Thoracic Surgery, Laveran Military medical Center, HIA Laveran, 34, boulevard Laveran, CS 50004, 13384 Marseille cedex13, France. Electronic address: paulbalandraud@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Balandraud
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005240:Feasibility Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000628:therapy; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D014951:Wounds, Stab / Q000628:therapy
keywords: Abdominal; Non-operative management; Penetrating trauma