The Evolution of Nonoperative Management of Abdominal Gunshot Wounds in the United States

Masjedi, Aaron; Asmar, Samer; Bible, Letitia; Khurrum, Muhammad; Chehab, Mohamad; Castañón, Lourdes; Ditillo, Michael; Joseph, Bellal

doi:10.1016/j.jss.2020.03.053

Cited by 4 publications

(3 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although a recent nationwide study showed the use of NOM for abdominal GSW has significantly increased in the United States, the results regarding the diagnostic accuracy of each CT finding may be different at an institution that has more conservative SNOM protocols. 40 In other words, the prevalence of HVI among the patients undergoing SNOM is expected to be lower when using more conservative protocols, thus the predictive values of each CT finding can be significantly different from our results. 41 By the same token, owing to the criteria for SNOM at our institution, patients that comprise this study may have more significant injuries that are more readily detectable on abdominal CT by the radiologists limiting the utility of these findings at other institutions where radiologists may be less familiar with patients undergoing CT scans with thoracoabdominal GSW.…”

Section: Discussioncontrasting

confidence: 90%

“…As aforementioned, there was an institutional protocol for SNOM of thoracoabdominal GSW during our study period. Although a recent nationwide study showed the use of NOM for abdominal GSW has significantly increased in the United States, the results regarding the diagnostic accuracy of each CT finding may be different at an institution that has more conservative SNOM protocols 40 . In other words, the prevalence of HVI among the patients undergoing SNOM is expected to be lower when using more conservative protocols, thus the predictive values of each CT finding can be significantly different from our results 41 .…”

Section: Discussioncontrasting

confidence: 79%

See 1 more Smart Citation

Diagnostic accuracy of computed tomography findings for hollow viscus injuries following thoracoabdominal gunshot wounds

Lian¹,

Ashbrook²,

Myers

et al. 2022

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

Section: Discussioncontrasting

confidence: 90%

Section: Discussioncontrasting

confidence: 79%

Diagnostic accuracy of computed tomography findings for hollow viscus injuries following thoracoabdominal gunshot wounds

Lian¹,

Ashbrook²,

Myers

et al. 2022

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…A recent database study found American hospitals selecting non-operative management of abdominal GSWs in roughly 25% of cases with excellent results, apostasy to an earlier generation of surgeons but now standard of care. 164 …”

Section: The Second World War and Beyondmentioning

confidence: 99%

‘Through and Through’ History: The Management of Gunshot Wounds From the 14th Century to the Present

Schalick

Horn

Marble

et al. 2023

Annals of Surgery Open

View full text Add to dashboard Cite

Gun violence killed over 46,000 Americans in 2021; almost 120,000 suffered gunshot wounds. This epidemic has attracted national attention and increasing concern from medical and surgical organizations, as evident in this special issue. ‘Through and Through History’ explores the surgical management of gunshot wounds from their earliest appearance in 14th-century Europe to the present. Interweaving the civilian and military experience, it details not only the evolution of care directly applied to patients but also the social, political, and scientific milieu that shaped decisions made and actions performed both in and out of the operating room. The article describes how surgeons have pushed the boundaries of medicine and science in each era, developing new therapies for their patients, a historical trend that persists today when such care has the potential to save tens of thousands of lives each year.

show abstract

Outcomes of selective non-operative management in adults with abdominal gunshot wounds: A systematic review and meta-analysis

Liu,

Fang,

Bai

et al. 2023

International Journal of Surgery

View full text Add to dashboard Cite

Background and Aims: Abdominal gunshot wounds (GSWs), a clinically devastating injury, can result in a variety of severe and lethal complications. Traditionally, exploratory laparotomy is the first-line approach for the management of abdominal GSWs, but associated with a considerable amount of unnecessary surgeries. At present, selective non-operative management (SNOM) of abdominal GSWs is becoming an effective and well-recognized approach, but remains widely disputed since many surgeons are skeptical about the validity of SNOM in clinical practice. This meta-analysis aims to estimate the outcomes of SNOM and immediate laparotomy in patients with GSWs by collecting the currently available evidence. Methods: The PubMed, EMBASE, and Cochrane Library databases were searched. A random-effects model was employed. Pooled proportion with 95% confidence intervals (CIs) was calculated. Heterogeneity was evaluated using the Cochran’s Q test and I2 statistics. Results: Overall, 53 studies involving 60,291 participants were included. The pooled proportions of SNOM and SNOM failure were 27.0% (95%CI=24.0%-30.0%) and 10.0% (95%CI=7.0%-13.0%), respectively. The pooled mortality after SNOM and SNOM failure were 0.0% (95%CI=0.0%-1.0%) and 0.0% (95%CI=0.0%-0.0%), respectively. The pooled proportions of immediate laparotomy and unnecessary immediate laparotomy were 73.0% (95%CI=70.0%-76.0%) and 10.0% (95%CI=8.0%-13.0%), respectively. The pooled mortality after immediate laparotomy and unnecessary immediate laparotomy were 10.0% (95%CI=8.0%-13.0%) and 0.0% (95%CI=0.0%-1.0%), respectively. Heterogeneity was statistically significant in nearly all meta-analyses. Conclusion: Immediate laparotomy is still the mainstay approach for the management of abdominal GSWs. Approximately one third of patients with abdominal GSWs undergo SNOM. SNOM failure is not frequent and its related mortality is also rare.

show abstract

The Evolution of Nonoperative Management of Abdominal Gunshot Wounds in the United States

Cited by 4 publications

References 35 publications

Diagnostic accuracy of computed tomography findings for hollow viscus injuries following thoracoabdominal gunshot wounds

Diagnostic accuracy of computed tomography findings for hollow viscus injuries following thoracoabdominal gunshot wounds

‘Through and Through’ History: The Management of Gunshot Wounds From the 14th Century to the Present

Outcomes of selective non-operative management in adults with abdominal gunshot wounds: A systematic review and meta-analysis

Contact Info

Product

Resources

About