Management of haemodynamically stable patients with abdominal stab wounds

Abstract

OBJECTIVES: Australasian trauma centres receive relatively low numbers of penetrating injuries from stabbings. There is limited agreement regarding protocols to guide the management of haemodynamically stable patients with penetrating injuries. This has resulted in a wide variation in practice with anecdotally high negative laparotomy rates. The aim of the present study was to review the ED procedures, investigations and disposition of this group of patients. METHODS: A retrospective review of all patients presenting with abdominal penetrating injury was undertaken over a 5 year period. Data on demographics, presenting features and management were collected. RESULTS: There were 109 patients who were haemodynamically stable (systolic blood pressure > 90) on arrival to the trauma centre. Diagnostic ED procedures and investigations consisted of wound exploration in 47 (43.1%) patients, focused abdominal sonography in trauma in 44 (40.4%) patients and a CT abdomen in 36 (33.0%) of patients. The sensitivity for focused abdominal sonography in trauma and CT when used together was 77.8%. There were 39 laparotomies performed with a negative laparotomy rate of 23.1%. There were 10 laparoscopies performed, none went on to require a laparotomy. Patients undergoing negative laparotomies spent significantly longer times in hospital than patients managed conservatively or those undergoing laparoscopies. CONCLUSIONS: The number of penetrating abdominal injuries remains low. Imaging alone cannot reliably exclude intraperitoneal injury. A greater utilization of ED wound exploration and laparoscopy based on agreed guidelines could improve management. An algorithm for the management of these patients is suggested.