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2010 Annual Meeting Abstracts

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Successful Selective Nonoperative Management Of Abdominal Gunshot Wounds Despite Low Penetrating Trauma Volumes
*Karim Fikry, George C Velmahos, *Athanasios Bramos, *Sumbal Janjua, *Marc de Moya, *David R King, *Hasan B Alam
Massachusetts General Hospital, Boston, MA

Objective: To evaluate if selective non-operative management (SNOM) of abdominal gunshot wounds (AGSW) is safe in trauma centers with a low volume of penetrating trauma.
Design: Retrospective study.
Setting: Academic Level 1 trauma center with approximately 10% penetrating trauma.
Patients: All patients with anterior and posterior AGSW (1/1 1999 - 12/31/2009), excluding tangential injuries, transfers, and deaths in ED. Patients with hemodynamic instability or peritonitis received an urgent laparotomy. The remaining had SNOM initially but some received a delayed laparotomy (DELLAP) based on worsening symptoms or worrisome CT findings.
Interventions: None.
Outcome measures: Hospital stay, complications, and mortality.
Results: Of 126 AGSW patients 49 (39%) were initially managed by SNOM (33% of anterior and 59% of posterior AGSW). 19 SNOM patients received DELLAP, the latest one 11 hours after admission. At the end, 24% of the patients were successfully managed without an operation (10% of anterior and 37% of posterior). There were no predictors of DELLAP. DELLAP patients had more complications, longer hospital stays, and a higher mortality compared to those with successful SNOM but no differences compared to those with urgent laparotomy. There was no serious complication or mortality attributed to DELLAP. A total of 11 patients (9%) had a non-therapeutic laparotomy and 3 of them (27%) developed complications.
Conclusion: SNOM of AGSW is feasible and safe in trauma centers with low penetrating trauma volumes. The volume of AGSW per se should not be an excuse for routine laparotomies, as approximately one out of four AGSW patients do not need it, and non-therapeutic laparotomies are associated with complications. This data becomes particularly important as penetrating trauma volumes are declining around the country.


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