A Study of the Predictive Value of the Primary Review and Complementary Examinations in Assessing the Need for Surgery in Patients With Stab Wounds in the Torso

Abstract

IntroductionObservation is the gold standard for stable patients with stab wounds. The aim of the study was to analyze the value of the primary review and complementary examinations to predict the need for surgery in stab wound patients in order to decrease observation times. MethodsA retrospective study of stab wound patients recorded in a database. Clinical and diagnostic workup parameters were analyzed. The main variable was the need for surgery. ResultsA total of 198 patients were included between 2006 and 2009, with a mean injury severity score (ISS) of 7.8±7, and 0.5% mortality. More than half (52%) of the patients suffered multiple wounds. Wound distribution was 23% neck, 46% thorax and 31% abdomen. Surgery was required in 73 (37%) patients (59% immediate, 27% delayed and 14% delayed). The need for surgery was associated with a lower revised trauma score (RTS), evisceration, active bleeding, and fascial penetration. Initial and control hemoglobin levels were significantly lower in patients who required surgery. A positive computerized tomography (CT) scan was associated with surgery. There were complications in 18% of patients, and they were more frequent in those who underwent surgery. There was no difference in complication rates between immediate and delayed (P=.72). Surgery was finally required in 10% of the patients with no abnormalities in the primary review and diagnostic workup, and 6% of those developed complications. ConclusionNone of the parameters studied could individually assess the need for surgery. Primary and secondary reviews were the most important diagnostic tool, but CT scan should be used more often. An observation period of 24h is recommended in torso penetrating wounds.