Negative trauma celiotomy

A retrospective review of 525 consecutive exploratory celiotomies for abdominal trauma occurring between January 1987 and June 1990 in an urban trauma center was conducted. One hundred-fifteen patients sustained blunt abdominal trauma (21%), and 410 patients sustained penetrating abdominal trauma (7...

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Bibliographic Details
Published in:	The American surgeon Vol. 59; no. 6; p. 365
Main Authors:	Henderson, V J, Organ, Jr, C H, Smith, R S
Format:	Journal Article
Language:	English
Published:	United States 01-06-1993
Subjects:	Abdomen - surgery Abdominal Injuries - diagnosis Abdominal Injuries - surgery California - epidemiology Diagnostic Techniques, Surgical Female Humans Incidence Laparotomy - adverse effects Laparotomy - statistics & numerical data Male Peritoneum - injuries Peritoneum - pathology Postoperative Complications Retrospective Studies Sensitivity and Specificity Wounds, Gunshot - diagnosis Wounds, Gunshot - surgery Wounds, Nonpenetrating - diagnosis Wounds, Nonpenetrating - surgery Wounds, Penetrating - diagnosis Wounds, Penetrating - surgery Wounds, Stab - diagnosis Wounds, Stab - surgery California
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Summary:	A retrospective review of 525 consecutive exploratory celiotomies for abdominal trauma occurring between January 1987 and June 1990 in an urban trauma center was conducted. One hundred-fifteen patients sustained blunt abdominal trauma (21%), and 410 patients sustained penetrating abdominal trauma (78%). Penetrating injuries included 260 gunshot wounds and 150 stab wounds. Patients were divided into three groups: Group A (16%), no visceral injuries identified at exploration (true negative); Group B, positive operative findings at celiotomy requiring no operative repair (10%) (nontherapeutic celiotomy); and Group C (74%), injuries encountered requiring operative repair (true positive). A positive exploration rate of 90 per cent with blunt trauma is acceptable using diagnostic techniques currently available. Similarly, a positive exploration rate of 85 per cent in gunshot wounds warrants our continued use of mandatory celiotomy. A 36 per cent combined incidence of true negatives and nontherapeutic celiotomies (Group A and B) is unacceptably high. To reduce this high incidence will require improved clinical surveillance and the controlled implementation of newer diagnostic techniques.
ISSN:	0003-1348