Selective non-operative management of abdominal gunshot wounds: Survey of practise

Academic Article

Abstract

  • Background: There is a growing body of evidence attesting to the effectiveness and safety of selective non-operative management (SNOM) of abdominal gunshot wounds. However, much of the research which supports this conclusion has originated from a few centres, and the actual utilisation of SNOM by trauma surgeons is not known. We therefore conducted a survey to assess the acceptance of this strategy and evaluate variations in practise. Methods: Electronic questionnaire survey of trauma surgeons in the United States of America, Canada, Brazil, and South Africa. Responses were compared using Chi and Fisher's exact tests. Results: 183 replies were received. 105 (57%) respondents practise SNOM of abdominal gunshot wounds, but there are marked regional variations in the acceptance of this strategy (p < 0.01). Respondents who had completed trauma (p < 0.01) or critical care (p < 0.01) fellowships, and those who practise in a higher volume centre (defined as >50 penetrating abdominal injuries seen per year) (p < 0.01) are more likely to practise SNOM of gunshot wounds. Most surgeons who practise SNOM regard peritonitis, omental and bowel evisceration, and being unable to evaluate a patient as a contraindication to attempting non-operative management. Almost all regard CT as essential. Respondents' preparedness to consider SNOM is related to injury extent. Conclusions: SNOM of abdominal gunshot wounds is practised by trauma surgeons in all four countries surveyed, but is not universally accepted, and there are variations in how it is practised. © 2012 Elsevier Ltd. 2
  • Authors

    Digital Object Identifier (doi)

    Author List

  • Jansen JO; Inaba K; Resnick S; Fraga GP; Starling SV; Rizoli SB; Boffard KD; Demetriades D
  • Start Page

  • 639
  • End Page

  • 644
  • Volume

  • 44
  • Issue

  • 5