January 1993

Prospective Alterations in Therapy for Penetrating Abdominal Trauma

Author Affiliations

From the Departments of Surgery, Tulane University, School of Medicine, New Orleans, La (Drs Nichols, Ozmen, McSwain, and Flint and Mr Smith, and Mss Muzik and Pearce), and the Huey P. Long Medical Center, Pineville, La (Dr Robertson).

Arch Surg. 1993;128(1):55-64. doi:10.1001/archsurg.1993.01420130059010

• In a double-blind, randomized study, 170 patients with traumatic perforation of the gastrointestinal tract were administered an advanced-generation cephalosporin. Patients were divided into infection risk groups (≤40%, low; 40% to 70%, mid; and >70%, high) at surgical closure using a logistic regression formula based on four proved risk factors—age, blood replacement, ostomy, and the number of organs injured. Patients in the low group received 2 days of antibiotic therapy; those in the mid to high group received 5 days of antibiotic therapy. Those patients in the low to mid group had primary wound closure; those in the high group had their wounds packed open and closed later. Most of the patients (144 [85%]) were in the low group. Their major and minor infection rates (10% and 12%, respectively) were not significantly different from 145 historic control subjects receiving 5 days of antibiotic therapy (9% major; 14% minor). Patients in the mid to high group showed a greater incidence of major infections (46%) but a similar incidence of minor infections (12%). The results indicate that risk factors can be used to identify low-risk patients who require only short-term antibiotic therapy and primary wound closure. The remaining patients are at greater risk for infection despite prolonged antibiotic therapy and delayed wound closure.

(Arch Surg. 1993;128:55-64)