Trauma centres increase use of non-surgical options for abdominal gunshot and stab wounds

An increasing number of abdominal gunshot and stab wounds are being treated without the need for unnecessary operations.

Researchers from The Johns Hopkins School of Medicine, USA, and the Aga Khan University in Pakistan reviewed nearly 26,000 patients with penetrating abdominal gunshot or stab injuries from the American College of Surgeons’ National Trauma Data Bank.

They focused on patients aged 16 years plus who survived long enough to be admitted to one of the 378 level one or two trauma centres for at least 24 hours. Just over half of the 25,737 patients (51%) had stab wounds and the remainder had gunshot wounds.

The study found that just over 22% of the gunshot wounds were treated using selective non-operative management (SNOM), together with just under 34% of stab wounds. The remainder of the surviving patients received laparotomy surgery.

‘SNOM rates for stab wounds increased by 50% between 2002 and 2008 and rates for gunshot injuries increased by 28%’ says co-author Dr Adil H Haider, associate professor of surgery and co-director of the Center for Surgery, Trials and Outcomes Research at Johns Hopkins. ‘This correlated with a decrease in the number of non-therapeutic laparotomies (NTL).

‘In most instances, failed SNOM was associated with increased death rates, underlining the importance of careful patient selection and protocols to reduce failure rates. However, it is important to point out that failure rates fell for both injuries during the seven-year study period and that successful SNOM was associated with shorter hospital stays.’

Key findings of the study included:
Gunshot wounds