Frequency of intra-abdominal organ injury is higher in patients with concomitant stab wounds to other anatomical areas

Igor Jeroukhimov, Itay Wiser, Yehuda Hershkovitz, Zahar Shapira, Kobi Peleg, Ricardo Alfici, Adi Givon, Israeli Trauma Group, Boris Kessel

Management of stable patients with abdominal stab wound remains controversial, particularly for those with no clear indications for explorative laparotomy. We evaluated the risk of intra-abdominal injury in stab wound victims concomitantly stabbed in other anatomical body areas. We performed a retrospective cohort study of patients with abdominal stab wounds recorded in the Israeli National Trauma Registry from January 1st, 1997, to December 31st, 2013. Patients with an isolated abdominal stab wound were compared to those with concomitant stab wounds to other anatomical areas. Intra-abdominal organ injury was defined by imaging or surgery findings. Multivariate analysis using a logistic regression model was conducted to assess independent risk for intra-abdominal organ injury. The study included 3964 patients. After controlling for age, gender and hypotension on arrival, patients with multi-regional stab wounds had an increased risk of intra-abdominal injury (OR = 1.3, CI 95% 1.1-1.6, p < 0.001). These patients also had a higher rate of injury to the solid organs than patients with an isolated abdominal stab wound. Patients with multi-regional stab wounds have an increased risk of intra-abdominal injury. Worldwide accepted "clinical follow up" protocol may not be appropriate in management of patients with multi-regional stab wounds.