Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia

  • Segni Kejela (Department of Surgery, Addis Ababa University College of Health Sciences) ;
  • Abel Hedato (Department of Surgery, Addis Ababa University College of Health Sciences) ;
  • Yeabsera Mekonnen Duguma (Department of Surgery, Addis Ababa University College of Health Sciences) ;
  • Meklit Solomon Gebremariam (Addis Ababa University College of Health Sciences)
  • Received : 2024.02.09
  • Accepted : 2024.05.21
  • Published : 2024.06.30
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Abstract

Purpose: Despite the high incidence of abdominal stab injuries, the rate of nontherapeutic laparotomies and the predictors of therapeutic laparotomies have rarely been studied in low-income settings. Methods: This multicenter retrospective study involved three of the largest academic medical centers in central Ethiopia. All patients who sustained an anterior abdominal stab injury and underwent exploratory laparotomy, regardless of the intraoperative findings, were included over the 3-year course of the study. Results: Of the 117 patients who underwent exploratory laparotomy, 35 patients (29.9%) underwent nontherapeutic laparotomies. Three factors predicted therapeutic laparotomy: hollow viscus evisceration (adjusted odds ratio [AOR], 5.77; 95% confidence interval [CI], 1.16-28.64; P=0.032), localized and generalized peritonitis (AOR, 4.77; 95% CI, 1.90-11.93; P=0.001), and white blood cell count ≥11,500/mm3 (AOR, 2.77; 95% CI, 1.002-7.650; P=0.049). The overall positive predictive value of the therapeutic predictors was 80.2%, while the negative predictive value of all predictor-negative patients was 58.1%. The predictors would have prevented 51.4% of the nontherapeutic laparotomies. Conclusions: Close to one-third of the patients had a nontherapeutic laparotomy. The clinical predictors of therapeutic laparotomy were shown to have a high positive predictive value despite a lower negative predictive value. Further prospective studies that involve all patients who sustain anterior abdominal stab injuries are needed to potentially improve on the negative predictive value of the predictors suggested by our study.

Keywords

Acknowledgement

The authors would like to acknowledge the contribution of faculty members in the Department of Surgery at Tikur Anbessa Specialized Hospital, Alert Hospital, and Zewditu Memorial Hospital in Addis Ababa, Ethiopia, where the study was conducted.

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