Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia.

Journal of Trauma and Injury Pub Date : 2024-06-01 Epub Date: 2024-06-19 DOI:10.20408/jti.2024.0009
Segni Kejela, Abel Hedato, Yeabsera Mekonnen Duguma, Meklit Solomon Gebremariam
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Abstract

Purpose: Despite the high incidence of abdominal stab injuries, the rate of nontherapeutic laparotomies and the predictors of therapeutic laparotomies have rarely been studied in low-income settings.

Methods: This multicenter retrospective study involved three of the largest academic medical centers in central Ethiopia. All patients who sustained an anterior abdominal stab injury and underwent exploratory laparotomy, regardless of the intraoperative findings, were included over the 3-year course of the study.

Results: Of the 117 patients who underwent exploratory laparotomy, 35 patients (29.9%) underwent nontherapeutic laparotomies. Three factors predicted therapeutic laparotomy: hollow viscus evisceration (adjusted odds ratio [AOR], 5.77; 95% confidence interval [CI], 1.16-28.64; P=0.032), localized and generalized peritonitis (AOR, 4.77; 95% CI, 1.90-11.93; P=0.001), and white blood cell count ≥11,500/mm3 (AOR, 2.77; 95% CI, 1.002-7.650; P=0.049). The overall positive predictive value of the therapeutic predictors was 80.2%, while the negative predictive value of all predictor-negative patients was 58.1%. The predictors would have prevented 51.4% of the nontherapeutic laparotomies.

Conclusions: Close to one-third of the patients had a nontherapeutic laparotomy. The clinical predictors of therapeutic laparotomy were shown to have a high positive predictive value despite a lower negative predictive value. Further prospective studies that involve all patients who sustain anterior abdominal stab injuries are needed to potentially improve on the negative predictive value of the predictors suggested by our study.

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前腹部刀刺伤进行治疗性开腹手术的临床预测因素:一项来自埃塞俄比亚低收入机构的多中心研究。
目的:尽管腹部刀刺伤的发生率很高,但在低收入环境中,非治疗性开腹手术的发生率和治疗性开腹手术的预测因素却很少被研究:这项多中心回顾性研究涉及埃塞俄比亚中部三个最大的学术医疗中心。这项多中心回顾性研究涉及埃塞俄比亚中部三个最大的学术医疗中心,在为期三年的研究过程中,所有腹部前部刺伤并接受探查性开腹手术的患者,无论术中结果如何,均被纳入研究范围:结果:在接受探查性开腹手术的117名患者中,有35名患者(29.9%)接受了非治疗性开腹手术。预测治疗性开腹手术的因素有三个:空腔脏器裂开(调整后的几率比 [AOR],5.77;95% 置信区间 [CI],1.16-28.64;P=0.032)、局部和全身腹膜炎(AOR,4.77;95% CI,1.90-11.93;P=0.001)和白细胞计数≥11,500/mm3(AOR,2.77;95% CI,1.002-7.650;P=0.049)。治疗预测因子的总体阳性预测值为 80.2%,而所有预测因子阴性患者的阴性预测值为 58.1%。这些预测值可避免 51.4% 的非治疗性开腹手术:结论:近三分之一的患者接受了非治疗性开腹手术。尽管阴性预测值较低,但治疗性开腹手术的临床预测值却很高。需要对所有前腹部刀刺伤患者进行进一步的前瞻性研究,以提高我们研究中提出的预测指标的阴性预测值。
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审稿时长
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