Prospective alterations in therapy for penetrating abdominal trauma
R. L. Nichols, J. W. Smith, G. D. Robertson, A. C. Muzik, P. Pearce, V. Ozmen, N. E. McSwain Jr and L. M. Flint
Department of Surgery, Tulane University, School of Medicine, New Orleans, La 70112.
In a double-blind, randomized study, 170 patients with traumatic
perforation of the gastrointestinal tract were administered an
advanced-generation cephalosporin. Patients were divided into infection
risk groups (< or = 40%, low; 40% to 70%, mid; and > 70%, high) at
surgical closure using a logistic regression formula based on four proved
risk factors--age, blood replacement, ostomy, and the number of organs
injured. Patients in the low group received 2 days of antibiotic therapy;
those in the mid to high group received 5 days of antibiotic therapy. Those
patients in the low to mid group had primary wound closure; those in the
high group had their wounds packed open and closed later. Most of the
patients (144 [85%]) were in the low group. Their major and minor infection
rates (10% and 12%, respectively) were not significantly different from 145
historic control subjects receiving 5 days of antibiotic therapy (9% major;
14% minor). Patients in the mid to high group showed a greater incidence of
major infections (46%) but a similar incidence of minor infections (12%).
The results indicate that risk factors can be used to identify low-risk
patients who require only short-term antibiotic therapy and primary wound
closure. The remaining patients are at greater risk for infection despite
prolonged antibiotic therapy and delayed wound closure.
