Penetrating abdominal trauma in the era of selective conservatism: a prospective cohort study in a level 1 trauma center
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ORIGINAL ARTICLE
Penetrating abdominal trauma in the era of selective conservatism: a prospective cohort study in a level 1 trauma center Anthony Sander1 · Richard Spence2 · James Ellsmere2 · Marius Hoogerboord2 · Sorin Edu1 · Andrew Nicol1 · Pradeep Navsaria1 Received: 6 March 2020 / Accepted: 21 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Global trend has seen management shift towards selective conservatism in penetrating abdominal trauma (PAT). The purpose of this study is to compare the presentation; management; and outcomes of patients with PAT managed operatively versus non-operatively. Methods Prospective cohort study of all patients Ùpresenting with PAT to Groote Schuur Hospital, Cape Town from 01 May 2015 to 30 April 2017. Presentation; management; and outcomes of patients were compared. Univariate predictors of delayed operative management (DOM) were explored. Results Over the 2-year study period, 805 patients with PAT were managed. There were 502 (62.4%); and 303 (37.6%) patients with gunshot (GSW) and stab wounds (SW), respectively. The majority were young men (94.7%), with a mean age of 28.3 years (95% CI 27.7–28.9) and median ISS of 13 (IQR 9–22). Successful non-operative management was achieved in 304 (37.7%) patients, and 501 (62.5%) were managed operatively. Of the operative cases, 477 (59.3%) underwent immediate laparotomy and 24 (3.0%) DOM. On univariate analysis, number; location; and mechanism of injuries were not associated with DOM. Rates of therapeutic laparotomy were achieved in 90.3% in the immediate, and 80.3% in the DOM cohorts. The mortality rate was 1.3, 11.3 and 0% in the in the NOM, immediate laparotomy and DOM subgroups, respectively. The rate of complications was no different in the immediate and DOM cohorts (p > 0.05). Conclusion Patients with PAT in the absence of haemodynamic instability; peritonism; organ evisceration; positive radiological findings, or an unreliable clinical examination, can be managed expectantly without increased morbidity or mortality. Keywords Penetrating trauma · Abdominal trauma · Non-operative management Penetrating abdominal trauma (PAT) in South Africa is amongst the most prevalent worldwide. In 2013, interpersonal violence was ranked 5th in all-cause mortality in Cape Town [1]. Groote Schuur Hospital (GSH) is a governmentfunded, tertiary teaching hospital situated in Cape Town, South Africa. It is the chief academic hospital of the University of Cape Town and one of the busiest trauma referral hospitals in the world, with an estimated 10,000 patients being seen in the trauma unit annually, 70% having sustained * Pradeep Navsaria [email protected] 1
Trauma Center—C14, Department of General Surgery, Groote Schuur Hospital and University of Cape Town, Observatory, Cape Town 7925, South Africa
Department of General Surgery, Dalhousie University, Halifax, Canada
2
intentional injuries of which 57% is of a penetrating mechanism. The current global trend in PAT has seen management s
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