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Anterior Abdominal Stab Wounds

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Validating the Western Trauma Association algorithm for managing patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial.
Biffl WL, Kaups KL, Pham TN, Rowell SE, Jurkovich GJ, Burlew CC, Elterman J, Moore EE.
J Trauma. 2011 Dec;71(6):1494-502.

Rationale for inclusion: This study validated the WTA algorithm for management of hemodyamically stable patients following anterior abdominal stab wounds.

Citations - 46 (as of July 2017)

Management of patients with anterior abdominal stab wounds: a Western Trauma Association multicenter trial.
Biffl WL, Kaups KL, Cothren CC, Brasel KJ, Dicker RA, Bullard MK, Haan JM, Jurkovich GJ, Harrison P, Moore FO, Schreiber M, Knudson MM, Moore EE.
J Trauma. 2009 May;66(5):1294-301.

Rationale for inclusion: A WTA multi-center trial, this study evaluated 359 patients with anterior abdominal stab wounds to determine optimal management, concluding that patients can be safely discharged following negative local wound exploration.  Patients with obvious peritoneal violation without ongoing hemorrhage or hollow viscus injury can be safely monitored with serial clinical exams.  

Citations - 95 (as of July 2017)

Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury--a prospective study in 200 patients.
Shanmuganathan K, Mirvis SE, Chiu WC, Killeen KL, Hogan GJ, Scalea TM.
Radiology. 2004 Jun;231(3):775-84.

Rationale for inclusion: This study evaluated the use of triple contrast CT imaging to identify peritoneal violation and visceral injury in patients with penetrating torso wounds.  It concluded that CT had 97% sensitivity, 98% specificity, and 98% accuracy with only 2 patients out of 200 requiring operative intervention with negative CT findings. 

Citations - 194 (as of July 2017)

Diagnostic laparoscopy in abdominal stab wounds: a prospective, randomized study.
Leppäniemi A, Haapiainen R.
J Trauma. 2003 Oct;55(4):636-45.

Rationale for inclusion: This study recommended against the routine use of diagnostic laparoscopy after anterolateral stab injuries.  Stable patients with evidence of peritoneal violation after sustaining abdominal stab wounds were randomized to either diagnostic laparoscopy or exploratory laparotomy, with little benefit to laparoscopy.  In similar patients with equivocal violation of the peritoneum on local wound exploration, laparoscopy identified more minor injuries but was associated with increased cost and hospital length of stay. 

Citations - 125 (as of July 2017)

A critical evaluation of laparoscopy in penetrating abdominal trauma.
Ivatury RR, Simon RJ, Stahl WM.
J Trauma. 1993 Jun;34(6):822-7; discussion 827-8.

Rationale for inclusion: Utilizing 100 stable patients with anterior penetrating wounds, this study concluded that diagnostic laparoscopy has excellent accuracy for identification of solid organ injuries, hemorrhage, and diaphragmatic lacerations, but its utility in identification of hollow viscus injury is limited beyond violation of the peritoneum, citing a high frequency of additional injuries found by subsequent laparotomy.

Citations - 322 (as of July 2017)

A prospective analysis of diagnostic laparoscopy in trauma.
Fabian TC, Croce MA, Stewart RM, Pritchard FE, Minard G, Kudsk KA.
Ann Surg. 1993 May;217(5):557-64; discussion 564-5.

Rationale for inclusion: This series introduced application of diagnostic laparoscopy to assess for intra-abdominal injury in hemodynamically stable patients to aid in diagnosis when other modalities were equivocal, performing efficacy, safety, and cost analyses.

Citations - 298 (as of July 2017)

Indications for operation in abdominal stab wounds. A prospective study of 651 patients.
Demetriades D, Rabinowitz B.
Ann Surg. 1987 Feb;205(2):129-32.

Rationale for inclusion: This study represents one of the first prospective evaluations of patients with anterior stab wounds to the abdomen, and concluded that the decision of operation or observation can be made on clinical exam alone.  

Citations - 260 (as of July 2017)

Evaluation of peritoneal lavage and local exploration in lower chest and abdominal stab wounds.
Thal ER.
J Trauma. 1977 Aug;17(8):642-8.

Rationale for inclusion: This series of 123 patients in 1977 first described the use of local exploration and diagnostic peritoneal lavage to successfully reduce the number of unnecessary laparotomies following anterior stab wounds. 

Citations - 152 (as of July 2017)

Indications for operation in abdominal trauma.
Shaftan GW.
Am J Surg. 1960 May;99:657-64.

Rationale for inclusion: Published in 1960, this remains one of the first and most cited early descriptions of the indication for laparotomy following abdominal injury.

Citations - 345 (as of July 2017)

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