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Results of a Prospective Study

Ali Salim, MD; Burapat Sangthong, MD; Matthew Martin, MD; Carlos Brown, MD; David Plurad, MD; Kenji Inaba, MD; Peter Rhee, MD; Demetrios Demetriades, MD

Arch Surg. 2006;141:745-752.

Hypothesis  Computed tomography (CT) can be used to evaluate patients with anterior abdominal stab wounds (AASWs).

Design  Prospective observational study.

Setting  Academic level I trauma center.

Patients and Methods  All of the patients sustaining AASWs, excluding those with hemodynamic instability, peritonitis, or omental evisceration, were admitted for serial abdominal examinations with or without CT depending on attending preference. Patients with associated left thoracoabdominal stab wounds underwent diagnostic laparoscopy.

Main Outcome Measures  Change in patient management as a direct result of the CT scan findings, as well as sensitivity, specificity, positive predictive value, and negative predictive value of CT scanning calculated against clinical outcome (the need for laparotomy, uneventful discharge without laparotomy, or return to the hospital for adverse events).

Results  One hundred fifty-six consecutive patients with AASWs were included over 24 months. Computed tomography was performed for 67 patients (CT group) whereas 89 patients were admitted for serial examination only (no-CT group). Nineteen of the 67 patients in the CT group had positive CT results, leading to laparotomy in 10 patients. Of the 48 patients with negative CT results, 3 underwent diagnostic laparoscopy for an associated thoracoabdominal stab wound and 2 eventually underwent laparotomy for clinical deterioration with negative results. Excluding patients with associated thoracoabdominal stab wounds, the negative predictive value of CT was 100%.

Conclusions  In patients with AASWs, CT can be used to identify visceral injuries. It is a promising tool that may identify patients who can be discharged after a shorter period of observation. Further evaluation of its use in patients with AASWs is warranted.

Author Affiliations: Division of Trauma and Critical Care, Department of Surgery, University of Southern California Keck School of Medicine and the Los Angeles County and University of Southern California Medical Center, Los Angeles.