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Eur J Trauma Emerg Surg. 2016 Dec;42(6):671-675. Epub 2015 Dec 1.

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

Kevric J1,2,3,4, O'Reilly GM5,6,7,8, Gocentas RA5,6,7,8, Hasip O5,6,7,8, Pilgrim C5,6,7,8, Mitra B5,6,7,8.

Author information

1
Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia. kevricj@gmail.com.
2
Emergency & Trauma Centre, The Alfred Hospital, Commercial Rd., Melbourne, VIC, 3004, Australia. kevricj@gmail.com.
3
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia. kevricj@gmail.com.
4
National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia. kevricj@gmail.com.
5
Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia.
6
Emergency & Trauma Centre, The Alfred Hospital, Commercial Rd., Melbourne, VIC, 3004, Australia.
7
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
8
National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia.

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.

KEYWORDS:

Abdominal trauma; General surgery; Trauma

PMID:
26626871
DOI:
10.1007/s00068-015-0605-x
[Indexed for MEDLINE]

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