Abdominal stab wounds

Diagnostic peritoneal lavage criteria for emergency room discharge

R. P. Gonzalez, B. Turk, Mark Falimirski, M. R. Holevar

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Objective: To prospectively evaluate a method for management of abdominal stab wounds that allows for immediate emergency room discharge. Methods: Anterior abdominal stab wound patients were prospectively placed in a study trial during a 48-month period. Consent was obtained for all patients before study entry. Anatomic boundaries for abdominal stab wounds were costal margins, inguinal ligaments, and anterior axillary lines. Hemodynamically stable patients with negative physical examinations were entered in the study and evaluated with closed diagnostic peritoneal lavage (DPL). Patients with DPL results less than 1000 RBCs/mm3 were sent home. Patients with DPL results greater than 1000 RBCs/mm3 (including gross blood) were admitted for observation. Hemodynamically stable patients with evisceration and no abdominal tenderness had the viscera replaced in the emergency room. Eviscerated patients did not undergo DPL and were admitted for observation. Patients that presented with hemodynamic instability or peritonitis were not entered in the study and underwent immediate surgical intervention. Results: Ninety hemodynamically stable patients were entered in the study. Forty-four (49%) patients had DPL <1000 RBCs/mm3, 34 of which were discharged home. Of the 10 admissions that qualified for discharge, 4 were admitted due to elevated ethanol levels and no family assistance, 3 were admitted to psychiatry, and 3 required other surgical procedures. No patient with DPL <1000 RBCs/mm3 required laparotomy or had complications associated with their stab wounds. Thirty-eight (42%) patients were observed because DPL counts were greater than 1000 RBCs/mm3. Eight (21%) of these patients developed positive physical examinations that prompted exploratory laparotomy, of which five (63%) were therapeutic. There were no complications associated with delayed laparotomy. Four (4%) patients had DPL results greater than 500 WBCs/mm3, all of which underwent immediate exploratory laparotomy. Four (4%) patients presented with evisceration, one of which underwent therapeutic laparotomy. Conclusion: Abdominal stab wound patients that are hemodynamically stable can be safely sent home from the emergency room when DPL counts are less than 1000 RBCs/mm3. Observation of hemodynamically stable patients allows for low laparotomy rates with minimal morbidity.

Original languageEnglish (US)
Pages (from-to)939-943
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume51
Issue number5
StatePublished - 2001
Externally publishedYes

Fingerprint

Stab Wounds
Peritoneal Lavage
Hospital Emergency Service
Laparotomy
Observation
Physical Examination
Viscera
Groin

ASJC Scopus subject areas

  • Surgery

Cite this

Abdominal stab wounds : Diagnostic peritoneal lavage criteria for emergency room discharge. / Gonzalez, R. P.; Turk, B.; Falimirski, Mark; Holevar, M. R.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 51, No. 5, 2001, p. 939-943.

Research output: Contribution to journalArticle

@article{576e4c6c06094d4b8fa385961f0214a9,
title = "Abdominal stab wounds: Diagnostic peritoneal lavage criteria for emergency room discharge",
abstract = "Objective: To prospectively evaluate a method for management of abdominal stab wounds that allows for immediate emergency room discharge. Methods: Anterior abdominal stab wound patients were prospectively placed in a study trial during a 48-month period. Consent was obtained for all patients before study entry. Anatomic boundaries for abdominal stab wounds were costal margins, inguinal ligaments, and anterior axillary lines. Hemodynamically stable patients with negative physical examinations were entered in the study and evaluated with closed diagnostic peritoneal lavage (DPL). Patients with DPL results less than 1000 RBCs/mm3 were sent home. Patients with DPL results greater than 1000 RBCs/mm3 (including gross blood) were admitted for observation. Hemodynamically stable patients with evisceration and no abdominal tenderness had the viscera replaced in the emergency room. Eviscerated patients did not undergo DPL and were admitted for observation. Patients that presented with hemodynamic instability or peritonitis were not entered in the study and underwent immediate surgical intervention. Results: Ninety hemodynamically stable patients were entered in the study. Forty-four (49{\%}) patients had DPL <1000 RBCs/mm3, 34 of which were discharged home. Of the 10 admissions that qualified for discharge, 4 were admitted due to elevated ethanol levels and no family assistance, 3 were admitted to psychiatry, and 3 required other surgical procedures. No patient with DPL <1000 RBCs/mm3 required laparotomy or had complications associated with their stab wounds. Thirty-eight (42{\%}) patients were observed because DPL counts were greater than 1000 RBCs/mm3. Eight (21{\%}) of these patients developed positive physical examinations that prompted exploratory laparotomy, of which five (63{\%}) were therapeutic. There were no complications associated with delayed laparotomy. Four (4{\%}) patients had DPL results greater than 500 WBCs/mm3, all of which underwent immediate exploratory laparotomy. Four (4{\%}) patients presented with evisceration, one of which underwent therapeutic laparotomy. Conclusion: Abdominal stab wound patients that are hemodynamically stable can be safely sent home from the emergency room when DPL counts are less than 1000 RBCs/mm3. Observation of hemodynamically stable patients allows for low laparotomy rates with minimal morbidity.",
author = "Gonzalez, {R. P.} and B. Turk and Mark Falimirski and Holevar, {M. R.}",
year = "2001",
language = "English (US)",
volume = "51",
pages = "939--943",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Abdominal stab wounds

T2 - Diagnostic peritoneal lavage criteria for emergency room discharge

AU - Gonzalez, R. P.

AU - Turk, B.

AU - Falimirski, Mark

AU - Holevar, M. R.

PY - 2001

Y1 - 2001

N2 - Objective: To prospectively evaluate a method for management of abdominal stab wounds that allows for immediate emergency room discharge. Methods: Anterior abdominal stab wound patients were prospectively placed in a study trial during a 48-month period. Consent was obtained for all patients before study entry. Anatomic boundaries for abdominal stab wounds were costal margins, inguinal ligaments, and anterior axillary lines. Hemodynamically stable patients with negative physical examinations were entered in the study and evaluated with closed diagnostic peritoneal lavage (DPL). Patients with DPL results less than 1000 RBCs/mm3 were sent home. Patients with DPL results greater than 1000 RBCs/mm3 (including gross blood) were admitted for observation. Hemodynamically stable patients with evisceration and no abdominal tenderness had the viscera replaced in the emergency room. Eviscerated patients did not undergo DPL and were admitted for observation. Patients that presented with hemodynamic instability or peritonitis were not entered in the study and underwent immediate surgical intervention. Results: Ninety hemodynamically stable patients were entered in the study. Forty-four (49%) patients had DPL <1000 RBCs/mm3, 34 of which were discharged home. Of the 10 admissions that qualified for discharge, 4 were admitted due to elevated ethanol levels and no family assistance, 3 were admitted to psychiatry, and 3 required other surgical procedures. No patient with DPL <1000 RBCs/mm3 required laparotomy or had complications associated with their stab wounds. Thirty-eight (42%) patients were observed because DPL counts were greater than 1000 RBCs/mm3. Eight (21%) of these patients developed positive physical examinations that prompted exploratory laparotomy, of which five (63%) were therapeutic. There were no complications associated with delayed laparotomy. Four (4%) patients had DPL results greater than 500 WBCs/mm3, all of which underwent immediate exploratory laparotomy. Four (4%) patients presented with evisceration, one of which underwent therapeutic laparotomy. Conclusion: Abdominal stab wound patients that are hemodynamically stable can be safely sent home from the emergency room when DPL counts are less than 1000 RBCs/mm3. Observation of hemodynamically stable patients allows for low laparotomy rates with minimal morbidity.

AB - Objective: To prospectively evaluate a method for management of abdominal stab wounds that allows for immediate emergency room discharge. Methods: Anterior abdominal stab wound patients were prospectively placed in a study trial during a 48-month period. Consent was obtained for all patients before study entry. Anatomic boundaries for abdominal stab wounds were costal margins, inguinal ligaments, and anterior axillary lines. Hemodynamically stable patients with negative physical examinations were entered in the study and evaluated with closed diagnostic peritoneal lavage (DPL). Patients with DPL results less than 1000 RBCs/mm3 were sent home. Patients with DPL results greater than 1000 RBCs/mm3 (including gross blood) were admitted for observation. Hemodynamically stable patients with evisceration and no abdominal tenderness had the viscera replaced in the emergency room. Eviscerated patients did not undergo DPL and were admitted for observation. Patients that presented with hemodynamic instability or peritonitis were not entered in the study and underwent immediate surgical intervention. Results: Ninety hemodynamically stable patients were entered in the study. Forty-four (49%) patients had DPL <1000 RBCs/mm3, 34 of which were discharged home. Of the 10 admissions that qualified for discharge, 4 were admitted due to elevated ethanol levels and no family assistance, 3 were admitted to psychiatry, and 3 required other surgical procedures. No patient with DPL <1000 RBCs/mm3 required laparotomy or had complications associated with their stab wounds. Thirty-eight (42%) patients were observed because DPL counts were greater than 1000 RBCs/mm3. Eight (21%) of these patients developed positive physical examinations that prompted exploratory laparotomy, of which five (63%) were therapeutic. There were no complications associated with delayed laparotomy. Four (4%) patients had DPL results greater than 500 WBCs/mm3, all of which underwent immediate exploratory laparotomy. Four (4%) patients presented with evisceration, one of which underwent therapeutic laparotomy. Conclusion: Abdominal stab wound patients that are hemodynamically stable can be safely sent home from the emergency room when DPL counts are less than 1000 RBCs/mm3. Observation of hemodynamically stable patients allows for low laparotomy rates with minimal morbidity.

UR - http://www.scopus.com/inward/record.url?scp=0035212743&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0035212743&partnerID=8YFLogxK

M3 - Article

VL - 51

SP - 939

EP - 943

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 5

ER -