Penetrating abdominal trauma in the era of selective conservatism: a prospective cohort study in a level 1 trauma center.
Background: Global trend has seen management shift towards selective conservatism in penetrating abdominal trauma (PAT). The purpose of this study is to compare the presentation; management; and outcomes of patients with PAT managed operatively versus non-operatively. Methods: Prospective cohort stu...
| Publicado en: | European Journal of Trauma & Emergency Surgery Vol. 48; no. 2; pp. 881 - 890 |
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| Autores principales: | , , , , , , |
| Formato: | algorithm research tables/charts Journal Article |
| Publicado: |
Springer Nature
Apr2022
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=156244294&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 156244294 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 18639933 3C05 jtl: European Journal of Trauma & Emergency Surgery issn: 18639933 maglogo: N pubinfo: dt: Apr2022 vid: 48 iid: 2 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 156244294 145486163 156244294 156244294 10.1007/s00068-020-01478-y 156244294 ppf: 881 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Penetrating abdominal trauma in the era of selective conservatism: a prospective cohort study in a level 1 trauma center. aug: au: Sander, Anthony Spence, Richard Ellsmere, James Hoogerboord, Marius Edu, Sorin Nicol, Andrew Navsaria, Pradeep affil: Trauma Center—C14, Department of General Surgery, Groote Schuur Hospital and University of Cape Town, Observatory, 7925, Cape Town, South Africa sug: subj: Abdominal Injuries Therapy Wounds, Penetrating Treatment Outcomes Human Prospective Studies Descriptive Statistics Confidence Intervals Male Female Adult Adult: 19-44 years Male Female ab: Background: Global trend has seen management shift towards selective conservatism in penetrating abdominal trauma (PAT). The purpose of this study is to compare the presentation; management; and outcomes of patients with PAT managed operatively versus non-operatively. Methods: Prospective cohort study of all patients Ùpresenting with PAT to Groote Schuur Hospital, Cape Town from 01 May 2015 to 30 April 2017. Presentation; management; and outcomes of patients were compared. Univariate predictors of delayed operative management (DOM) were explored. Results: Over the 2-year study period, 805 patients with PAT were managed. There were 502 (62.4%); and 303 (37.6%) patients with gunshot (GSW) and stab wounds (SW), respectively. The majority were young men (94.7%), with a mean age of 28.3 years (95% CI 27.7–28.9) and median ISS of 13 (IQR 9–22). Successful non-operative management was achieved in 304 (37.7%) patients, and 501 (62.5%) were managed operatively. Of the operative cases, 477 (59.3%) underwent immediate laparotomy and 24 (3.0%) DOM. On univariate analysis, number; location; and mechanism of injuries were not associated with DOM. Rates of therapeutic laparotomy were achieved in 90.3% in the immediate, and 80.3% in the DOM cohorts. The mortality rate was 1.3, 11.3 and 0% in the in the NOM, immediate laparotomy and DOM subgroups, respectively. The rate of complications was no different in the immediate and DOM cohorts (p > 0.05). Conclusion: Patients with PAT in the absence of haemodynamic instability; peritonism; organ evisceration; positive radiological findings, or an unreliable clinical examination, can be managed expectantly without increased morbidity or mortality. pubtype: Academic Journal doctype: algorithm research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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