Clinical Evaluation of Abdominal Stab Wound Patients in the ED

복부 자상환자의 처치에 대한 응급의학에서의 고찰

  • Park, Jong-Hak (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Kim, Jung-Youn (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Shin, Jun-Hyun (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Yoon, Young-Hoon (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Cho, Han-Jin (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Moon, Sung-Woo (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Choi, Sung-Hyuk (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Lee, Sung-Woo (Department of Emergency Medicine, College of Medicine, Korea University) ;
  • Hong, Yun-Sik (Department of Emergency Medicine, College of Medicine, Korea University)
  • 박종학 (고려대학교 의과대학 응급의학교실) ;
  • 김정윤 (고려대학교 의과대학 응급의학교실) ;
  • 신준현 (고려대학교 의과대학 응급의학교실) ;
  • 윤영훈 (고려대학교 의과대학 응급의학교실) ;
  • 조한진 (고려대학교 의과대학 응급의학교실) ;
  • 문성우 (고려대학교 의과대학 응급의학교실) ;
  • 최성혁 (고려대학교 의과대학 응급의학교실) ;
  • 이성우 (고려대학교 의과대학 응급의학교실) ;
  • 홍윤식 (고려대학교 의과대학 응급의학교실)
  • Received : 2010.05.07
  • Accepted : 2010.06.08
  • Published : 2010.06.30

Abstract

Purpose: In Korea, most abdominal penetrating wounds are caused by stab wounds rather than gun-shot wounds. However, not many studies have been performed on stab injuries and their epidemiologic characteristics. Disagreements of opinions of obligatory surgical exploration and conservative treatment exist, and this subject is still being debated. Therefore, the authors studied the epidemiologic characteristics of abdominal stab wound patients visiting the emergency department and reviewed the proportion of patients that received nontherapeutic surgery and conservative treatment. Methods: This study included patients visiting the emergency department with abdominal stab wounds. A retrospective chart review was done on the abdominal stab wound patients. Sex, age, cause of injury, location of wound, initial vital signs, operation results, injured organs and CT & LWE results were reviewed. Results: The median age of the 121 patients was 40.9 years, of these patients, 88 were males, of which 52 (43.0%) were drunken. Of the patients that received non-therapeutic operations, only 3 patients (15.0%) were drunken, significantly lower than the therapeutic operation group. For the location of the wound, most patients were injured in the right and left upper quadrants, 27 patients each. The most common injured organ was the small bowel; 13 patients were injured in the small bowel. With abdominal CT scans and local wound explorations together, the results exhibited a sensitivity of 97%, a specificity of 44%, a positive predictive value of 56%, and a negative predictive value of 95%. Conclusion: In our study, the sensitivity was 97% when CT & LWE were performed together; thus we can conclude that CT and LWE can be used together to select the treatment method. Although in our study, the surgical indications in abdominal stab wound patients is not sufficient, our results showed a higher rate of nontherapeutic surgery compared to previous studies. Therefore, more research is needed to prevent unnecessary laparotomies in hemodynamically-stable patients without symptoms.

Keywords

References

  1. Shaftan GW. Indication for operation in abdominal trauma. Am J Surg 1960;657-64.
  2. Nance FC, Wenner MH, Johnson LW. Ingram JC Jr, CohnI Jr. Surgical judgment in the management of penetrating wounds of the abdomen: experience with 2212 patients. Ann Surg 1974;179:639-46. https://doi.org/10.1097/00000658-197405000-00017
  3. Van Brussel M, Van Hee R: Abdominal stab wounds. A five-year patients review. Eur J Emerg Med 2001;8:83-8. https://doi.org/10.1097/00063110-200103000-00051
  4. Bostrom L, Heinius G, Nilsson B. Trends in the incidence and severity of stab wounds in Sweden 1987-1994. Eur J Surg 2000;166:765-70. https://doi.org/10.1080/110241500447380
  5. Taviloglu K. When to operate on abdominal stab wounds. Scand J Surg 2002;91:58-61. https://doi.org/10.1177/145749690209100109
  6. Leppaniemi AK, Haapiainen RK. Selective nonoperative management of abdominal stab wounds, prospective randomized study. World J Surg 1996;20:1101-5. https://doi.org/10.1007/s002689900168
  7. Ko YG, Kim BJ, Baek KJ, Cho YU, Kin JS. A clinical analysis of abdominal stab injuries for five years. Korean Soc Emerg Med 2003;14:536-43.
  8. Yoo SJ, Park JH. A clinical analysis of the abdominal stab wounds. Korean Soc Emerg Med 1995;6:77-88.
  9. Park SH, Kwon KH, Min HS. The clinical evaluation of the anterior abdominal stab wounds. J Korean Surg Soc 1990;38:74-83.
  10. Lee HH, Choi SH, Yun SS, Lee S, Park IY, Park SM, Lim KW. Clinical analysis of patients with stab wound. Korean Soc Emerg Med 1997;8:111-20.
  11. Lee JH, Chi HS, Park KI, Kim CK. Surgical management of abdominal stab wound. J Korean Surg Soc 1985;28:550-9.
  12. Cayten CG, Frangiopane L, Poladora F, Inouye W. Abdominal stab wounds: a ten-year review of 204 patients. Am Surg 1982;48:250-4.
  13. Biffl WL, Kaups KL, Cothren CC, Brasel KJ, Dicker RA, Bullard MK, et al. Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial. J Trauma 2009;66:1294-301. https://doi.org/10.1097/TA.0b013e31819dc688
  14. Thompson JS, Moore EE, Van Duzer-Moore S, Moore JB, Galloway AC. The evolution of abdominal stab wound management. J Trauma. 1980;20:478-484. https://doi.org/10.1097/00005373-198006000-00008
  15. Leppaniemi AK, Voutilainen PE, Haapiainen RK. Indications for early mandatory laparotomy in abdominal stab wounds. Br J Surg. 1999;86:76-80. https://doi.org/10.1046/j.1365-2168.1999.00968.x
  16. Nagy K, Roberts R, Joseph K, An G, Barrett J. Evisceration after abdominal stab wounds: is laparotomy required? J Trauma. 1999;47:622-624. https://doi.org/10.1097/00005373-199910000-00002
  17. Shanmuganathan K, Mirvis SE, Chiu WC, Killeen KL, Hogan GJ, Scalea TM. Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury-a prospective study in 200 patients. Radiology. 2004;231:775-784. https://doi.org/10.1148/radiol.2313030126
  18. Cho YD, Hong YS, Lee SW, Choi SH, Yoon YH, Lim SI, et al. Impact of initial helical abdominal computed tomography on the diagnosis of hollow viscus injury and blunt abdominal trauma. Korean Soc Emerg Med 2008;21:28-35.
  19. Feliciano DV, Mattox KL, Moore EE. Trauma. 6th ed. New York: McGraw-Hill, 2008.
  20. Asensio JA, Trunkey DD. Current Therapy of trauma and surgical critical care. 1st ed. Philadelphia :Mosby Elsevier, 2008.
  21. Ramirez RM, Cureton EL, Ereso AQ, Kwan RO, Dozier KC, Sadjadi J, et al. Single-contrast computed tomography for triage of patients with penetrating torso trauma. J Trauma 2009;67:583-8. https://doi.org/10.1097/TA.0b013e3181a39330