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Shaftan  GW Indications for operation in abdominal trauma.  Am J Surg 1960;99657- 664PubMedGoogle ScholarCrossref
Nance  FCWennar  MHJohnson  LWIngram  JC  JrCohn  I  Jr Surgical judgment in the management of penetrating wounds of the abdomen: experience with 2212 patients.  Ann Surg 1974;179639- 645PubMedGoogle ScholarCrossref
McAlvanah  MJShaftan  GW Selective conservatism in penetrating abdominal wounds: a continuing reappraisal.  J Trauma 1978;18206- 212PubMedGoogle ScholarCrossref
Phillips  TSclafani  SJGoldstein  AScalea  TPanetta  TShaftan  G Use of the contrast-enhanced CT enema in the management of penetrating trauma to the flank and back.  J Trauma 1986;26593- 601PubMedGoogle ScholarCrossref
Hauser  CJHuprich  JEBosco  PGibbons  LMansour  AYWeiss  AR Triple-contrast computed tomography in the evaluation of penetrating posterior abdominal injuries.  Arch Surg 1987;1221112- 1115PubMedGoogle ScholarCrossref
McAllister  EPerez  MAlbrinck  MHOlsen  SMRosemurgy  AS Is triple contrast computed tomographic scanning useful in the selective management of stab wounds to the back?  J Trauma 1994;37401- 403PubMedGoogle ScholarCrossref
Velmahos  GCConstantinou  CTillou  ABrown  CVSalim  ADemetriades  D Abdominal computed tomographic scan for patients with gunshot wounds to the abdomen selected for nonoperative management.  J Trauma 2005;591155- 1161PubMedGoogle ScholarCrossref
Munera  FMorales  CSoto  JA  et al.  Gunshot wounds of abdomen: evaluation of stable patients with triple-contrast helical CT.  Radiology 2004;231399- 405PubMedGoogle ScholarCrossref
Grossman  MDMay  AKSchwab  CW  et al.  Determining anatomic injury with computed tomography in selected torso gunshot wounds.  J Trauma 1998;45446- 456PubMedGoogle ScholarCrossref
Ginzburg  ECarrillo  EHKopelman  T  et al.  The role of computed tomography in selective management of gunshot wounds to the abdomen and flank.  J Trauma 1998;451005- 1009PubMedGoogle ScholarCrossref
Chiu  WCShanmuganathan  KMirvis  SEScalea  TM Determining the need for laparotomy in penetrating torso trauma: a prospective study using triple contrast enhanced abdominopelvic computed tomography.  J Trauma 2001;51860- 869PubMedGoogle ScholarCrossref
Shanmuganathan  KMirvis  SEChiu  WCKilleen  KLHogan  GJScalea  TM Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury: a prospective study in 200 patients.  Radiology 2004;231775- 784PubMedGoogle ScholarCrossref
Demetriades  DRabinowitz  B Indications for operation in abdominal stab wounds: a prospective study of 651 patients.  Ann Surg 1987;205129- 132PubMedGoogle ScholarCrossref
Shorr  RMGottlieb  MMWebb  KIshiguro  LBerne  TV Selective management of abdominal stab wounds: importance of the physical examination.  Arch Surg 1988;1231141- 1145PubMedGoogle ScholarCrossref
van Haarst  EPvan Bezooijen  BPCoene  PPLuitse  JS The efficacy of serial abdominal examination in penetrating abdominal trauma.  Injury 1999;30599- 604PubMedGoogle ScholarCrossref
Tsikitis  VBiffl  WLMajercik  SHarrington  DTCioffi  WG Selective clinical management of anterior abdominal stab wounds.  Am J Surg 2004;188807- 812PubMedGoogle ScholarCrossref
Thal  ER Evaluation of peritoneal lavage and local exploration in lower chest and abdominal stab wounds.  J Trauma 1977;17642- 648PubMedGoogle ScholarCrossref
Oreskovich  MRCarrico  CJ Stab wounds of the anterior abdomen: analysis of a management plan using local wound exploration and quantitative peritoneal lavage.  Ann Surg 1983;198411- 419PubMedGoogle ScholarCrossref
Gonzalez  RPTurk  BFalimirski  MEHolevar  MR Abdominal stab wounds: diagnostic peritoneal lavage criteria for emergency room discharge.  J Trauma 2001;51939- 943PubMedGoogle ScholarCrossref
Demetriades  DGomez  HChahwan  S  et al.  Gunshot injuries to the liver: the role of selective nonoperative management.  J Am Coll Surg 1999;188343- 348PubMedGoogle ScholarCrossref
Renz  BMFeliciano  DV Gunshot wounds to the right thoracoabdomen: a prospective study of nonoperative management.  J Trauma 1994;37737- 744PubMedGoogle ScholarCrossref
Murray  JADemetriades  DAsensio  JA  et al.  Occult injuries to the diaphragm: prospective evaluation of laparoscopy in penetrating injuries to the left lower chest.  J Am Coll Surg 1998;187626- 630PubMedGoogle ScholarCrossref
Ivatury  RRZantut  LFYelon  JA Laparoscopy in the new century.  Surg Clin North Am 1999;791291- 1295PubMedGoogle ScholarCrossref
Villavicencio  RTAucar  JA Analysis of laparoscopy in trauma.  J Am Coll Surg 1999;18911- 20PubMedGoogle ScholarCrossref
Soffer  DMcKenney  MGCohn  S  et al.  A prospective evaluation of ultrasonography for the diagnosis of penetrating torso injury.  J Trauma 2004;56953- 959PubMedGoogle ScholarCrossref
Udobi  KFRodriguez  AChiu  WCScalea  TM Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study.  J Trauma 2001;50475- 479PubMedGoogle ScholarCrossref
Boulanger  BRKearney  PATsuei  BOchoa  JB The routine use of sonography in penetrating torso injury is beneficial.  J Trauma 2001;51320- 325PubMedGoogle ScholarCrossref
Kirkpatrick  AWSirois  MBall  CG  et al.  The hand-held ultrasound examination for penetrating abdominal trauma.  Am J Surg 2004;187660- 665PubMedGoogle ScholarCrossref
Rehm  CGSherman  RHinz  TW The role of CT scan in evaluation for laparotomy in patients with stab wounds of the abdomen.  J Trauma 1989;29446- 450PubMedGoogle ScholarCrossref
Soto  JAMorales  CMunera  FSanabria  AGuevara  JMSuarez  T Penetrating stab wounds to the abdomen: use of serial US and contrast-enhanced CT in stable patients.  Radiology 2001;220365- 371PubMedGoogle ScholarCrossref
Fakhry  SMWatts  DDLuchette  FAEAST Multi-Institutional Hollow Viscus Injury Research Group, Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275 557 trauma admissions from the EAST multi-institutional HVI trial.  J Trauma 2003;54295- 306PubMedGoogle ScholarCrossref
Malhotra  AKFabian  TCKatsis  SBGavant  MLCroce  MA Blunt bowel and mesenteric injuries: the role of screening computed tomography.  J Trauma 2000;48991- 998PubMedGoogle ScholarCrossref
August 1, 2006

Use of Computed Tomography in Anterior Abdominal Stab Wounds: Results of a Prospective Study

Author Affiliations

Author Affiliations: Division of Trauma and Critical Care, Department of Surgery, University of Southern California Keck School of Medicine and the Los Angeles County and University of Southern California Medical Center, Los Angeles.

Arch Surg. 2006;141(8):745-752. doi:10.1001/archsurg.141.8.745

Hypothesis  Computed tomography (CT) can be used to evaluate patients with anterior abdominal stab wounds (AASWs).

Design  Prospective observational study.

Setting  Academic level I trauma center.

Patients and Methods  All of the patients sustaining AASWs, excluding those with hemodynamic instability, peritonitis, or omental evisceration, were admitted for serial abdominal examinations with or without CT depending on attending preference. Patients with associated left thoracoabdominal stab wounds underwent diagnostic laparoscopy.

Main Outcome Measures  Change in patient management as a direct result of the CT scan findings, as well as sensitivity, specificity, positive predictive value, and negative predictive value of CT scanning calculated against clinical outcome (the need for laparotomy, uneventful discharge without laparotomy, or return to the hospital for adverse events).

Results  One hundred fifty-six consecutive patients with AASWs were included over 24 months. Computed tomography was performed for 67 patients (CT group) whereas 89 patients were admitted for serial examination only (no-CT group). Nineteen of the 67 patients in the CT group had positive CT results, leading to laparotomy in 10 patients. Of the 48 patients with negative CT results, 3 underwent diagnostic laparoscopy for an associated thoracoabdominal stab wound and 2 eventually underwent laparotomy for clinical deterioration with negative results. Excluding patients with associated thoracoabdominal stab wounds, the negative predictive value of CT was 100%.

Conclusions  In patients with AASWs, CT can be used to identify visceral injuries. It is a promising tool that may identify patients who can be discharged after a shorter period of observation. Further evaluation of its use in patients with AASWs is warranted.