Selective nonoperative management of abdominal gunshot wounds with isolated solid organ injury

Reed, Benjamin L.; Patel, Neel; McDonald, Amy A.; Baughman, W. Christopher; Claridge, Jeffrey A.; Como, John J.

doi:10.1016/j.amjsurg.2016.11.027

Cited by 8 publications

(6 citation statements)

References 12 publications

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“…Since then, the selective nonoperative management for abdominal cavity stab wounds has been widely accepted, which has not been the case for those caused by firearm projectiles. The term selective conservatism does not only mean the 6,7,8,9,10,11,12,13,14,15). criteria for non-surgical decision-making will depend on surveillance by the surgical team that will evaluate and manage these patients clinically.…”

Section: Resultsmentioning

confidence: 99%

Selective conservative treatment for anterior abdominal gunshot: a literature narrative review

Silva

Sorrentino

2020

Rev. Col. Bras. Cir.

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ABSTRACT The nonoperative treatment of anterior abdominal gunshot wounds remains controversial. This article presents a narrative review of the literature after the selection of studies in electronic databases (PubMed, Cochrane Library and Lilacs), with the intention of evaluating the clinical and diagnostic tools that should be part of conservative selective approach of these lesions. It was observed that a nonoperative selective treatment can be effectively and safely used, when performed by a trained interdisciplinary team, working in adequate trauma centers. The selective nonoperative treatment is associated with a decrease in negative and nontherapeutic laparotomies, reducing the incidence of complications. It also contributes to the reduction of hospital costs.

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Section: Resultsmentioning

confidence: 99%

Selective conservative treatment for anterior abdominal gunshot: a literature narrative review

Silva

Sorrentino

2020

Rev. Col. Bras. Cir.

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“…of abdo GSWs No. abdo GSWs treated with SNOM Mean age (years) Mean ISS Reported SNOM characteristics Frequency of physical exam Serial examination done by Serial laboratory examination Use of CT Reed et al [ 65 ] (USA, 2017) Retrospective 2003–2014 NR 127 63 26 17 NR NR NR Selective Peponis et al [ 35 ] (USA, 2017) Retrospective 1996–2015 I and II 922 215 NR NR Serial Trauma team NR Selective Starling et al [ 59 ] (Brazil, 2015) Prospective 2005–2014 NR 169 28 27.7 10.9 NR NR Yes Mandatory Navsaria et al [ 45 ] (SA, 2015) Prospective 2004–2009 I 1106 272 27.9 NR Serial NR Yes Selective Laing et al [ 30 ] (SA, 2014) Retrospective 2012–2013 NR 80 15 28 NR 4-hourly for 12–24 h Surgical trainee NR Mandatory Cesar et al [ 61 ] (Brazil, 2013) Prospective 2005–2012 NR NR 37 24 16 NR NR NR Mandat...…”

Section: Resultsmentioning

confidence: 99%

“…Twenty studies (48.8%) reported the length of time from admission to delayed laparotomy in patients that failed SNOM. The weighted mean and median time between admission and delayed laparotomy in patients selected for a trial of SNOM ( n = 16 studies, 39.0%) was 40.6 and 21.2 h, respectively [ 12 , 31 , 35 , 38 , 40 , 41 , 43 , 45 – 47 , 49 , 51 , 60 , 63 , 65 , 66 ].…”

Section: Resultsmentioning

confidence: 99%

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Outcomes of selective nonoperative management of civilian abdominal gunshot wounds: a systematic review and meta-analysis

et al. 2018

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BackgroundAlthough mandatory laparotomy has been standard of care for patients with abdominal gunshot wounds (GSWs) for decades, this approach is associated with non-therapeutic operations, morbidity, and long hospital stays. This systematic review and meta-analysis sought to summarize outcomes of selective nonoperative management (SNOM) of civilian abdominal GSWs.MethodsWe searched electronic databases (March 1966–April 1, 2017) and reference lists of articles included in the systematic review for studies reporting outcomes of SNOM of civilian abdominal GSWs. We meta-analyzed the associated risks of SNOM-related failure (defined as laparotomy during hospital admission), mortality, and morbidity across included studies using DerSimonian and Laird random-effects models. Between-study heterogeneity was assessed by calculating I2 statistics and conducting tests of homogeneity.ResultsOf 7155 citations identified, we included 41 studies [n = 22,847 patients with abdominal GSWs, of whom 6777 (29.7%) underwent SNOM]. The pooled risk of failure of SNOM in hemodynamically stable patients without a reduced level of consciousness or signs of peritonitis was 7.0% [95% confidence interval (CI) = 3.9–10.1%; I2 = 92.6%, homogeneity p < 0.001] while the pooled mortality associated with use of SNOM in this patient population was 0.4% (95% CI = 0.2–0.6%; I2 = 0%, homogeneity p > 0.99). In patients who failed SNOM, the pooled estimate of the risk of therapeutic laparotomy was 68.0% (95% CI = 58.3–77.7%; I2 = 91.5%; homogeneity p < 0.001). Risks of failure of SNOM were lowest in studies that evaluated patients with right thoracoabdomen (3.4%; 95% CI = 0–7.0%; I2 = 0%; homogeneity p = 0.45), flank (7.0%; 95% CI = 3.9–10.1%), and back (3.1%; 95% CI = 0–6.5%) GSWs and highest in those that evaluated patients with anterior abdomen (13.2%; 95% CI = 6.3–20.1%) GSWs. In patients who underwent mandatory abdominopelvic computed tomography (CT), the pooled risk of failure was 4.1% versus 8.3% in those who underwent selective CT (p = 0.08). The overall sample-size-weighted mean hospital length of stay among patients who underwent SNOM was 6 days versus 10 days if they failed SNOM or developed an in-hospital complication.ConclusionsSNOM of abdominal GSWs is safe when conducted in hemodynamically stable patients without a reduced level of consciousness or signs of peritonitis. Failure of SNOM may be lower in patients with GSWs to the back, flank, or right thoracoabdomen and be decreased by mandatory use of abdominopelvic CT scans.Electronic supplementary materialThe online version of this article (10.1186/s13017-018-0215-0) contains supplementary material, which is available to authorized users.

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“…Se incluyeron 127 pacientes, de los cuales el 50 % recibió este tipo de tratamiento (cuyo uso aumentó durante el tiempo de estudio de 31 % a 67 %), sin diferencia en los resultados con respecto a quienes fueron sometidos inicialmente a tratamiento quirúrgico. No obstante, con el manejo selectivo no operatorio, se observaron estancias hospitalarias más cortas, menor necesidad de transfusión de células rojas empaquetadas y menos complicaciones 25 . Esto es similar a lo encontrado por Peponis, et al, en 2017, en una revisión retrospectiva multicéntrica de 1996 a 2015, sobre un total de 922 pacientes con este mismo tipo de heridas, de los cuales el 23 % recibió manejo selectivo no operatorio; de estos, solo el 8,4 % requirió laparotomía posteriormente 26 .…”

Section: Discussionunclassified

Manejo no operatorio de las heridas abdominales por arma de fuego basado en la tomografía computarizada

2018

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Trabajo presentado durante el Congreso Nacional de Cirugía 2017, concurso Simposio Nacional del Residente Quirúrgico ResumenObjetivo. Determinar la utilidad de la tomografía computadorizada (TC) en la selección para manejo no operatorio de pacientes con heridas abdominales por arma de fuego. Materiales y métodos. Se llevó a cabo un estudio observacional con la información de 62 pacientes mayores de 15 años con heridas por arma de fuego sin indicación de cirugía emergente, a quienes se les practicó TC de abdomen con triple contraste. Resultados. Se analizaron 276 pacientes con heridas por arma de fuego; a su ingreso, 214 se sometieron a cirugía urgente y a 62 se les practicó TC. De estos 62, en 14 estuvo indicada la cirugía por la TC, de los cuales, 12 tuvieron lesiones que requerían manejo quirúrgico y en dos la laparotomía no fue terapéutica. En los restantes 48 pacientes, la TC indicó manejo no operatorio. No obstante, en 2 de estos, se practicaron laparotomías tempranas, las cuales fueron terapéuticas. Los otros 46 pacientes recibieron manejo no operatorio: 43 fueron dados de alta sin complicaciones y 3 fueron sometidos posteriormente a laparotomía que resultó no terapéutica. Se presentó una tasa global de intervenciones no terapéuticas de 10,1 % y manejo no operatorio exitoso en 69,3 %. La sensibilidad de de la TC fue de 85,7 % (IC 95% 63,8-100 %), la especificidad de 95,8 % (IC 95% 89,1% -100%), el valor predictivo positivo de 85,7% (IC 95% 63,8%-100%), valor predictivo negativo de 95,8% (IC 95% 89,1%-100%); la razón de verisimilitud de un resultado positivo (Likelihood Ratio, LR + ) fue de 21,5 y el de un resultado negativo (LR -) fue de 0,15. Conclusión. La TC es segura y confiable para predecir si los pacientes con heridas abdominales por arma de fuego son candidatos a manejo no operatorio. Palabras clave: traumatismos abdominales; heridas penetrantes; heridas por arma de fuego; tomografía; laparotomía.

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Selective nonoperative management of abdominal gunshot wounds with isolated solid organ injury

Cited by 8 publications

References 12 publications

Selective conservative treatment for anterior abdominal gunshot: a literature narrative review

Selective conservative treatment for anterior abdominal gunshot: a literature narrative review

Outcomes of selective nonoperative management of civilian abdominal gunshot wounds: a systematic review and meta-analysis

Manejo no operatorio de las heridas abdominales por arma de fuego basado en la tomografía computarizada

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