The evolution of the diagnostic work-up for stab wounds to the back and flank

Tam N. Pham, Eric Heinberg, Joseph Cuschieri, Eileen M. Bulger, Grant E. O'Keefe, Joel A. Gross, Gregory Jurkovich

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Stab wounds to the back and flank infrequently cause injuries requiring operative treatment. Triple-contrast CT scan (3CT) has essentially replaced diagnostic peritoneal lavage (DPL) as the primary means of identifying patients who require operative intervention. This study aims to review the evolution of the diagnostic work-up for stab wounds to the back and flank. Methods: We performed a retrospective review of haemodynamically stable patients with stab wound to the back or flank treated at a single Level 1 trauma centre over a 10-year period. Diagnostic accuracy of DPL and 3CT screening tests were evaluated against the patient's subsequent clinical course. The elapsed time between emergency department (ED) presentation and test results was recorded and compared. Results: A total of 177 patients were identified. 76 patients had stab wounds isolated to the back, 90 had stab wounds isolated to the flank and 11 had wounds in both locations. CT ultimately became the predominant initial diagnostic test during the study period. Although less frequently used over time, DPL retained good sensitivity and specificity for injuries requiring operative intervention (92% and 83%, respectively). 3CT identified all injuries requiring laparotomy (100% sensitivity) and had a specificity of 96%. 3CT was a more time-consuming process, with results available at a median of 3:31 h after arrival to the ED, as compared to 1:03 h for DPL (p < 0.01). Conclusions: 3CT diagnosed all injuries requiring operative intervention, and its use was associated with a lower rate of non-therapeutic laparotomies. However, average time to diagnosis by 3CT was prolonged compared to DPL. Although 3CT has become the predominant diagnostic test when evaluating patients with stab wounds to the back and flank at our institution, efforts to further expedite the diagnostic work-up are necessary.

Original languageEnglish (US)
Pages (from-to)48-53
Number of pages6
JournalInjury
Volume40
Issue number1
DOIs
StatePublished - Jan 1 2009
Externally publishedYes

Fingerprint

Stab Wounds
Peritoneal Lavage
Wounds and Injuries
Routine Diagnostic Tests
Laparotomy
Hospital Emergency Service
Trauma Centers
Sensitivity and Specificity

Keywords

  • Accuracy
  • CT scan
  • Diagnostic peritoneal lavage
  • Laparotomy

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Pham, T. N., Heinberg, E., Cuschieri, J., Bulger, E. M., O'Keefe, G. E., Gross, J. A., & Jurkovich, G. (2009). The evolution of the diagnostic work-up for stab wounds to the back and flank. Injury, 40(1), 48-53. https://doi.org/10.1016/j.injury.2008.09.014

The evolution of the diagnostic work-up for stab wounds to the back and flank. / Pham, Tam N.; Heinberg, Eric; Cuschieri, Joseph; Bulger, Eileen M.; O'Keefe, Grant E.; Gross, Joel A.; Jurkovich, Gregory.

In: Injury, Vol. 40, No. 1, 01.01.2009, p. 48-53.

Research output: Contribution to journalArticle

Pham, TN, Heinberg, E, Cuschieri, J, Bulger, EM, O'Keefe, GE, Gross, JA & Jurkovich, G 2009, 'The evolution of the diagnostic work-up for stab wounds to the back and flank', Injury, vol. 40, no. 1, pp. 48-53. https://doi.org/10.1016/j.injury.2008.09.014
Pham TN, Heinberg E, Cuschieri J, Bulger EM, O'Keefe GE, Gross JA et al. The evolution of the diagnostic work-up for stab wounds to the back and flank. Injury. 2009 Jan 1;40(1):48-53. https://doi.org/10.1016/j.injury.2008.09.014
Pham, Tam N. ; Heinberg, Eric ; Cuschieri, Joseph ; Bulger, Eileen M. ; O'Keefe, Grant E. ; Gross, Joel A. ; Jurkovich, Gregory. / The evolution of the diagnostic work-up for stab wounds to the back and flank. In: Injury. 2009 ; Vol. 40, No. 1. pp. 48-53.
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abstract = "Background: Stab wounds to the back and flank infrequently cause injuries requiring operative treatment. Triple-contrast CT scan (3CT) has essentially replaced diagnostic peritoneal lavage (DPL) as the primary means of identifying patients who require operative intervention. This study aims to review the evolution of the diagnostic work-up for stab wounds to the back and flank. Methods: We performed a retrospective review of haemodynamically stable patients with stab wound to the back or flank treated at a single Level 1 trauma centre over a 10-year period. Diagnostic accuracy of DPL and 3CT screening tests were evaluated against the patient's subsequent clinical course. The elapsed time between emergency department (ED) presentation and test results was recorded and compared. Results: A total of 177 patients were identified. 76 patients had stab wounds isolated to the back, 90 had stab wounds isolated to the flank and 11 had wounds in both locations. CT ultimately became the predominant initial diagnostic test during the study period. Although less frequently used over time, DPL retained good sensitivity and specificity for injuries requiring operative intervention (92{\%} and 83{\%}, respectively). 3CT identified all injuries requiring laparotomy (100{\%} sensitivity) and had a specificity of 96{\%}. 3CT was a more time-consuming process, with results available at a median of 3:31 h after arrival to the ED, as compared to 1:03 h for DPL (p < 0.01). Conclusions: 3CT diagnosed all injuries requiring operative intervention, and its use was associated with a lower rate of non-therapeutic laparotomies. However, average time to diagnosis by 3CT was prolonged compared to DPL. Although 3CT has become the predominant diagnostic test when evaluating patients with stab wounds to the back and flank at our institution, efforts to further expedite the diagnostic work-up are necessary.",
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AB - Background: Stab wounds to the back and flank infrequently cause injuries requiring operative treatment. Triple-contrast CT scan (3CT) has essentially replaced diagnostic peritoneal lavage (DPL) as the primary means of identifying patients who require operative intervention. This study aims to review the evolution of the diagnostic work-up for stab wounds to the back and flank. Methods: We performed a retrospective review of haemodynamically stable patients with stab wound to the back or flank treated at a single Level 1 trauma centre over a 10-year period. Diagnostic accuracy of DPL and 3CT screening tests were evaluated against the patient's subsequent clinical course. The elapsed time between emergency department (ED) presentation and test results was recorded and compared. Results: A total of 177 patients were identified. 76 patients had stab wounds isolated to the back, 90 had stab wounds isolated to the flank and 11 had wounds in both locations. CT ultimately became the predominant initial diagnostic test during the study period. Although less frequently used over time, DPL retained good sensitivity and specificity for injuries requiring operative intervention (92% and 83%, respectively). 3CT identified all injuries requiring laparotomy (100% sensitivity) and had a specificity of 96%. 3CT was a more time-consuming process, with results available at a median of 3:31 h after arrival to the ED, as compared to 1:03 h for DPL (p < 0.01). Conclusions: 3CT diagnosed all injuries requiring operative intervention, and its use was associated with a lower rate of non-therapeutic laparotomies. However, average time to diagnosis by 3CT was prolonged compared to DPL. Although 3CT has become the predominant diagnostic test when evaluating patients with stab wounds to the back and flank at our institution, efforts to further expedite the diagnostic work-up are necessary.

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