Nonoperative Management of Renal Stab Wounds

Introduction Penetrating thoracic trauma is common and costly. Injuries are frequently and selectively amenable to non-operative management. Our selective approach to penetrating thoracic trauma is reviewed and the effectiveness of our clinical algorithms confirmed. Additionally, a basic cost analysis was undertaken to evaluate the financial impact of a selective nonoperative management approach to penetrating thoracic trauma. Materials and methods The Pietermaritzburg Metropolitan Trauma Services electronic regional trauma registry hybrid electronic medical records were reviewed, highlighted all penetrating thoracic traumas. A micro-cost analysis estimated expenses for active observation, tube thoracostomy for isolated pneumothorax greater than 2 cm and tube thoracostomy for haemothorax. Routine thoracic computed tomography does not form part of these algorithms. Results Isolated thoracic stab wounds occurred in 589 patients. Eighty per cent (472 cases) were successfully managed nonoperatively. Micro-costing shows that active observation costs 4,370 ZAR (£270), tube thoracostomy for isolated pneumothorax costs 6,630 ZAR (£400) and tube thoracostomy for haemothorax costs 21,850 ZAR (£1,310). Discussion Penetrating thoracic trauma places a striking financial burden on our limited resources. Diligent and serial clinical assessments, alongside basic radiology and stringent management criteria, can accurately stratify patients to correct clinical algorithms. Conclusion Selective nonoperative management for penetrating thoracic trauma is safe and effective. Routine thoracic computed tomography is unnecessary in all patients with isolated thoracic stab wounds, which can be reserved for a select group who are identifiable clinically. Routine thoracic computed tomography would not be financially prudent across Pietermaritzburg Metropolitan Trauma Services. Government action is required to reduce the overall incidence of such trauma to save resources and patients.

Download Full-text

Management of Patients with Evisceration after Abdominal Stab Wounds

The American Surgeon ◽

10.1177/000313481408001016 ◽

2014 ◽

Vol 80 (10) ◽

pp. 984-988 ◽

Cited By ~ 3

Author(s):

Kristina Nicholson ◽

Kenji Inaba ◽

Dimitra Skiada ◽

Obi Okoye ◽

Lydia Lam ◽

...

Keyword(s):

Nonoperative Management ◽

Diagnostic Yield ◽

Descriptive Analysis ◽

Vital Signs ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Stab Wounds ◽

Level I ◽

Operative Findings ◽

Abdominal Stab Wounds

In the era of nonoperative management of abdominal stab wounds, the optimal management of patients with evisceration remains unclear. Furthermore, the role of imaging in guiding management of these patients has not been defined. Patients admitted to a Level I trauma center (2005 to 2012) with evisceration after an abdominal stab wound were retrospectively identified. Demographics, admission vital signs, topography and contents of evisceration, Glasgow Coma Score, indications for exploration, and imaging and operative reports were abstracted. Clinical outcomes measured were: injuries identified on exploration, hospital length of stay, and mortality. Descriptive analysis was performed. Ninety-three patients with evisceration were identified. Ninety-two (98.9%) were male and 60 (64.5%) were Hispanic. Mean age was 31.9 ± 13 years. Forty-seven (50.5%) had evisceration of the omentum, 41 (44.1%) had evisceration of abdominal organs, and two (2.2%) had both. Seventy-four (80.4%) had positive laparotomies. Ten (10.8%) underwent computed tomography (CT) preoperatively. Sixty per cent of CT findings were congruent with operative findings. CT did not impact clinical management. In conclusion, the rate of intra-abdominal injury in patients with evisceration remains high. Even in the age of nonoperative management, evisceration continues to be an indication for immediate laparotomy. The diagnostic yield of CT is low and CT should not impact management of these patients.

Download Full-text