Abstract
BackgroundManagement of stable patients with abdominal stab wound remains controversial, particularly for those with no clear indications for explorative laparotomy. We evaluated the risk of intra-abdominal injury in stab wound victims concomitantly stabbed in other anatomical body areas.MethodsWe performed a retrospective cohort study of patients with abdominal stab wounds recorded in the Israeli National Trauma Registry from January 1st, 1997, to December 31st, 2013. Patients with an isolated abdominal stab wound were compared to those with concomitant stab wounds to other anatomical areas. Intra-abdominal organ injury was defined by imaging or surgery findings. Multivariate analysis using a logistic regression model was conducted to assess independent risk for intra-abdominal organ injury.ResultsThe study included 3964 patients. After controlling for age, gender and hypotension on arrival, patients with multi-regional stab wounds had an increased risk of intra-abdominal injury (OR = 1.3, CI 95% 1.1–1.6, p < 0.001). These patients also had a higher rate of injury to the solid organs than patients with an isolated abdominal stab wound.ConclusionsPatients with multi-regional stab wounds have an increased risk of intra-abdominal injury. Worldwide accepted “clinical follow up” protocol may not be appropriate in management of patients with multi-regional stab wounds.
Highlights
Management of stable patients with abdominal stab wound remains controversial, for those with no clear indications for explorative laparotomy
Participants We found 438,765 trauma victims in the Israeli National Trauma Registry between the years 1997 to 2013
The multi-regional stab wounds group had a significantly higher rate of hypotension on arrival and Glasgow Comma Scale (GCS) ≤8 compared to the group with an isolated stab wound (9.3% vs 5.5%, p < 0.0001 and 4.1% vs. 1.3%, p < 0.0001; respectively)
Summary
Management of stable patients with abdominal stab wound remains controversial, for those with no clear indications for explorative laparotomy. Non-operative management is a widely accepted approach for the stable patient with an abdominal stab wound who does not require urgent surgery [2,3,4]. The management approach for patients with multi-regional stab wounds including the abdomen is not distinguished from those with isolated abdominal stab wounds. We assume that the management approach to the patients with multiple abdominal stab wound may be different from those with isolated abdominal stab wound. That was intuitively based on idea that multiple stab wounds have potentially worse mechanism of injury and higher probability to penetrate peritoneal cavity and cause more damage. We hypothesized that the rate of intra-abdominal injury is higher in patients with multi-regional stab wounds compare to patients with isolated abdominal stab wounds
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