The utility of laparoscopic evaluation of the parietal peritoneum in the management of anterior abdominal stab wounds

Mona Shah, Joseph M Galante, Lynette A. Scherer, Garth H Utter

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background Trauma centres vary in their approaches to managing stable patients with anterior abdominal stab wounds (AASWs), with no approach yet proven superior. We sought to evaluate the performance of screening laparoscopy (i.e., parietal peritoneal penetration or not) in determining which patients should undergo laparotomy. Methods We conducted a retrospective case series study, including all patients with an AASW who presented to U.C. Davis Medical Center from January 2003 through March 2009. We collected data from medical records using a standardised, pre-tested instrument. Among laparoscopically screened cases, we determined the test characteristics of peritoneal penetration for detecting intra-abdominal injury. We sub-classified injuries as "requiring treatment" (e.g., full-thickness enterotomy or active haemorrhage) or not. Results Of 358 patients with AASWs, 163 underwent screening laparoscopy. Seventy-eight of the 163 (48%) had no peritoneal penetration and six (4%) had peritoneal penetration but a low-risk wound; none of these 84 underwent laparotomy nor had a missed injury. Of 79 patients with peritoneal penetration who underwent laparotomy, 61 had an intra-abdominal injury, of whom 42 were treated intraoperatively. Among these 42, 30 had an injury "requiring treatment." The PPV of peritoneal penetration for an injury requiring treatment was 38% (30/79) (95% CI 27-50%), NPV 100% (84/84) (95% CI 95-100%), sensitivity 100% (30/30) (95% CI 88-100%), and specificity 63% (84/133) (95% CI 54-71%). The negative and positive likelihood ratios were 0 (95% CI 0-0.4) and 2.7 (95% CI 2.2-3.4), respectively. Conclusions Screening laparoscopic evaluation of the parietal peritoneum results in a negligible rate of missed injury and an approximately 40% rate of finding an injury requiring treatment.

Original languageEnglish (US)
Pages (from-to)128-133
Number of pages6
JournalInjury
Volume45
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Stab Wounds
Peritoneum
Wounds and Injuries
Laparotomy
Abdominal Injuries
Laparoscopy
Trauma Centers
Therapeutics
Medical Records
Hemorrhage

Keywords

  • Algorithm
  • Anterior abdomen
  • Penetrating abdominal trauma
  • Peritoneal penetration
  • Screening laparoscopy
  • Stab wound

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

The utility of laparoscopic evaluation of the parietal peritoneum in the management of anterior abdominal stab wounds. / Shah, Mona; Galante, Joseph M; Scherer, Lynette A.; Utter, Garth H.

In: Injury, Vol. 45, No. 1, 01.2014, p. 128-133.

Research output: Contribution to journalArticle

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title = "The utility of laparoscopic evaluation of the parietal peritoneum in the management of anterior abdominal stab wounds",
abstract = "Background Trauma centres vary in their approaches to managing stable patients with anterior abdominal stab wounds (AASWs), with no approach yet proven superior. We sought to evaluate the performance of screening laparoscopy (i.e., parietal peritoneal penetration or not) in determining which patients should undergo laparotomy. Methods We conducted a retrospective case series study, including all patients with an AASW who presented to U.C. Davis Medical Center from January 2003 through March 2009. We collected data from medical records using a standardised, pre-tested instrument. Among laparoscopically screened cases, we determined the test characteristics of peritoneal penetration for detecting intra-abdominal injury. We sub-classified injuries as {"}requiring treatment{"} (e.g., full-thickness enterotomy or active haemorrhage) or not. Results Of 358 patients with AASWs, 163 underwent screening laparoscopy. Seventy-eight of the 163 (48{\%}) had no peritoneal penetration and six (4{\%}) had peritoneal penetration but a low-risk wound; none of these 84 underwent laparotomy nor had a missed injury. Of 79 patients with peritoneal penetration who underwent laparotomy, 61 had an intra-abdominal injury, of whom 42 were treated intraoperatively. Among these 42, 30 had an injury {"}requiring treatment.{"} The PPV of peritoneal penetration for an injury requiring treatment was 38{\%} (30/79) (95{\%} CI 27-50{\%}), NPV 100{\%} (84/84) (95{\%} CI 95-100{\%}), sensitivity 100{\%} (30/30) (95{\%} CI 88-100{\%}), and specificity 63{\%} (84/133) (95{\%} CI 54-71{\%}). The negative and positive likelihood ratios were 0 (95{\%} CI 0-0.4) and 2.7 (95{\%} CI 2.2-3.4), respectively. Conclusions Screening laparoscopic evaluation of the parietal peritoneum results in a negligible rate of missed injury and an approximately 40{\%} rate of finding an injury requiring treatment.",
keywords = "Algorithm, Anterior abdomen, Penetrating abdominal trauma, Peritoneal penetration, Screening laparoscopy, Stab wound",
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N2 - Background Trauma centres vary in their approaches to managing stable patients with anterior abdominal stab wounds (AASWs), with no approach yet proven superior. We sought to evaluate the performance of screening laparoscopy (i.e., parietal peritoneal penetration or not) in determining which patients should undergo laparotomy. Methods We conducted a retrospective case series study, including all patients with an AASW who presented to U.C. Davis Medical Center from January 2003 through March 2009. We collected data from medical records using a standardised, pre-tested instrument. Among laparoscopically screened cases, we determined the test characteristics of peritoneal penetration for detecting intra-abdominal injury. We sub-classified injuries as "requiring treatment" (e.g., full-thickness enterotomy or active haemorrhage) or not. Results Of 358 patients with AASWs, 163 underwent screening laparoscopy. Seventy-eight of the 163 (48%) had no peritoneal penetration and six (4%) had peritoneal penetration but a low-risk wound; none of these 84 underwent laparotomy nor had a missed injury. Of 79 patients with peritoneal penetration who underwent laparotomy, 61 had an intra-abdominal injury, of whom 42 were treated intraoperatively. Among these 42, 30 had an injury "requiring treatment." The PPV of peritoneal penetration for an injury requiring treatment was 38% (30/79) (95% CI 27-50%), NPV 100% (84/84) (95% CI 95-100%), sensitivity 100% (30/30) (95% CI 88-100%), and specificity 63% (84/133) (95% CI 54-71%). The negative and positive likelihood ratios were 0 (95% CI 0-0.4) and 2.7 (95% CI 2.2-3.4), respectively. Conclusions Screening laparoscopic evaluation of the parietal peritoneum results in a negligible rate of missed injury and an approximately 40% rate of finding an injury requiring treatment.

AB - Background Trauma centres vary in their approaches to managing stable patients with anterior abdominal stab wounds (AASWs), with no approach yet proven superior. We sought to evaluate the performance of screening laparoscopy (i.e., parietal peritoneal penetration or not) in determining which patients should undergo laparotomy. Methods We conducted a retrospective case series study, including all patients with an AASW who presented to U.C. Davis Medical Center from January 2003 through March 2009. We collected data from medical records using a standardised, pre-tested instrument. Among laparoscopically screened cases, we determined the test characteristics of peritoneal penetration for detecting intra-abdominal injury. We sub-classified injuries as "requiring treatment" (e.g., full-thickness enterotomy or active haemorrhage) or not. Results Of 358 patients with AASWs, 163 underwent screening laparoscopy. Seventy-eight of the 163 (48%) had no peritoneal penetration and six (4%) had peritoneal penetration but a low-risk wound; none of these 84 underwent laparotomy nor had a missed injury. Of 79 patients with peritoneal penetration who underwent laparotomy, 61 had an intra-abdominal injury, of whom 42 were treated intraoperatively. Among these 42, 30 had an injury "requiring treatment." The PPV of peritoneal penetration for an injury requiring treatment was 38% (30/79) (95% CI 27-50%), NPV 100% (84/84) (95% CI 95-100%), sensitivity 100% (30/30) (95% CI 88-100%), and specificity 63% (84/133) (95% CI 54-71%). The negative and positive likelihood ratios were 0 (95% CI 0-0.4) and 2.7 (95% CI 2.2-3.4), respectively. Conclusions Screening laparoscopic evaluation of the parietal peritoneum results in a negligible rate of missed injury and an approximately 40% rate of finding an injury requiring treatment.

KW - Algorithm

KW - Anterior abdomen

KW - Penetrating abdominal trauma

KW - Peritoneal penetration

KW - Screening laparoscopy

KW - Stab wound

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