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European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 6/2016

01-12-2016 | Original Article

Management of haemodynamically stable patients with penetrating abdominal stab injuries: review of practice at an Australian major trauma centre

Authors: J. Kevric, G. M. O’Reilly, R. A. Gocentas, O. Hasip, C. Pilgrim, B. Mitra

Published in: European Journal of Trauma and Emergency Surgery | Issue 6/2016

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Abstract

Introduction

The management of haemodynamically stable patients who present following a penetrating abdominal injury (PAI) remains variable between mandatory surgical exploration and more selective non-operative approaches. The primary aim of this study was to assess compliance with an algorithm guiding selective non-operative management of haemodynamically stable patients with PAI. The secondary aim was to examine the association between compliance and unnecessary laparotomies.

Methods

This was a retrospective cohort study involving all patients with PAI that presented to a major trauma centre from January 2007 to December 2011. Data were extracted from the trauma registry and patients’ electronic medical records.

Results

There were 189 patients included in the study, of which 79 (41.8 %) patients complied with the algorithm. The laparotomy rate in the setting of algorithm compliance was significantly lower than algorithm non-compliance (12.7 vs. 68.2 %; p < 0.01) as were unnecessary laparotomy rates (0 vs. 33.3 %; p = 0.03).

Conclusion

Among haemodynamically stable patients presenting with PAI, compliance with an algorithm guiding selective non-operative management was low, but associated with lower laparotomy and lower unnecessary laparotomy rates. Improved compliance with algorithms directed towards selective non-operative management of PAI should be encouraged with stringent vigilance towards patient safety.
Literature
1.
O’Mullane PA, Mikocka-Walus AA, Gabbe BJ, Cameron PA. Incidence and outcomes of major trauma assaults: a population-based study in Victoria. Med J Aust. 2009;190:129–32.PubMed
2.
Ogilvie R, Curtis K, Palmer C, Lam M, McCloughen A, Foster K. Incidence and outcomes of major trauma patients managed in the Australian Capital Territory. ANZ J Surg. 2014;84:433–7.CrossRefPubMed
3.
Boyle MJ, Smith EC, Archer FL. Trauma incidents attended by emergency medical services in Victoria, Australia. Prehosp Disaster Med. 2008;23:20–8.CrossRefPubMed
4.
Smith GA. Knife-related injuries treated in United States emergency departments, 1990–2008. J Emerg Med. 2013;45:315–23.CrossRefPubMed
5.
Mendes JF, Mathee A, Naicker N, Becker P, Naidoo S. The prevalence of intentional and unintentional injuries in selected Johannesburg housing settlements. S Afr Med J =Suid-Afrikaanse tydskrif vir geneeskunde. 2011;101(835–6):38.
6.
Rozen WM, Ma EH, Jones IT, Judson RT. Emerging epidemic in Australia: abdominal stab wounds. Twenty-four months at a major trauma centre. Emerg Med Aust: EMA. 2007;19:262–8.CrossRef
7.
Rotondo MF, Schwab CW, McGonigal MD, et al. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35:375–82 (discussion 82–3).CrossRefPubMed
8.
Sugrue M, Balogh Z, Lynch J, Bardsley J, Sisson G, Weigelt J. Guidelines for the management of haemodynamically stable patients with stab wounds to the anterior abdomen. ANZ J Surg. 2007;77:614–20.CrossRefPubMed
9.
Schmelzer TM, Mostafa G, Gunter OL Jr, Norton HJ, Sing RF. Evaluation of selective treatment of penetrating abdominal trauma. J Surg Educ. 2008;65:340–5.CrossRefPubMed
10.
Nicholas JM, Rix EP, Easley KA, et al. Changing patterns in the management of penetrating abdominal trauma: the more things change, the more they stay the same. J Trauma. 2003;55:1095–108 (discussion 108–10).CrossRefPubMed
11.
Ball CG. Current management of penetrating torso trauma: nontherapeutic is not good enough anymore. Can J Surg Journal canadien de chirurgie. 2014;57:E36–43.CrossRefPubMed
12.
Cothren CC, Moore EE, Warren FA, Kashuk JL, Biffl WL, Johnson JL. Local wound exploration remains a valuable triage tool for the evaluation of anterior abdominal stab wounds. Am J Surg. 2009;198:223–6.CrossRefPubMed
13.
Biffl WL, Kaups KL, Cothren CC, et al. Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma. 2009;66:1294–301.CrossRefPubMed
14.
Jansen JO, Inaba K, Rizoli SB, Boffard KD, Demetriades D. Selective non-operative management of penetrating abdominal injury in Great Britain and Ireland: survey of practice. Injury. 2012;43:1799–804.CrossRefPubMed
15.
Mitra B, Gocentas R, O’Reilly G, Cameron PA, Atkin C. Management of haemodynamically stable patients with abdominal stab wounds. Emerg Med Aust: EMA. 2007;19:269–75.CrossRef
16.
Gilbert EH, Lowenstein SR, Koziol-McLain J, Barta DC, Steiner J. Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med. 1996;27:305–8.CrossRefPubMed
17.
Ertekin C, Yanar H, Taviloglu K, Guloglu R, Alimoglu O. Unnecessary laparotomy by using physical examination and different diagnostic modalities for penetrating abdominal stab wounds. Emerg Med J: EMJ. 2005;22:790–4.CrossRefPubMedPubMedCentral
18.
Khanna S, Boyle J, Good N, Lind J. New emergency department quality measure: from access block to National Emergency Access Target compliance. Emerg Med Aust: EMA. 2013;25:565–72.CrossRef
19.
Perera ML, Davies AW, Gnaneswaran N, et al. Clearing emergency departments and clogging wards: national Emergency Access Target and the law of unintended consequences. Emerg Med Aust: EMA. 2014;26:549–55.CrossRef
20.
Como JJ, Bokhari F, Chiu WC, et al. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma. 2010;68:721–33.CrossRefPubMed
21.
Beitner MM, Suh N, Dowling R, Miller JA. Penetrating liver injury managed with a combination of balloon tamponade and venous stenting: a case report and literature review. Injury. 2012;43:119–22.CrossRefPubMed
22.
Clarke DL, Allorto NL, Thomson SR. An audit of failed non-operative management of abdominal stab wounds. Injury. 2010;41:488–91.CrossRefPubMed
23.
Navsaria PH, Berli JU, Edu S, Nicol AJ. Non-operative management of abdominal stab wounds–an analysis of 186 patients. S Afr J Surg Suid-Afrikaanse tydskrif vir chirurgie. 2007;45:128–30, 32.
24.
Demetriades D, Hadjizacharia P, Constantinou C, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg. 2006;244:620–8.PubMedPubMedCentral
Metadata
Title
Management of haemodynamically stable patients with penetrating abdominal stab injuries: review of practice at an Australian major trauma centre
Authors
J. Kevric
G. M. O’Reilly
R. A. Gocentas
O. Hasip
C. Pilgrim
B. Mitra
Publication date
01-12-2016
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 6/2016
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-015-0605-x

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