Outcomes of selective nonoperative management of civilian abdominal gunshot wounds: a systematic review and meta-analysis

Autor:	Christopher J. Doig, Chad G. Ball, Fatma A. Al Hinai, Jamie M. Boyd, Andrew W. Kirkpatrick, George C. Velmahos, Derek J. Roberts, Pradeep H. Navsaria, Aziza N. Al Rawahi
Jazyk:	angličtina
Rok vydání:	2018
Předmět:	medicine.medical_specialty medicine.medical_treatment lcsh:Surgery Peritonitis Abdominal Injuries 030230 surgery Risk Assessment 03 medical and health sciences Injury Severity Score 0302 clinical medicine Level of consciousness Trauma Centers Laparotomy Abdominal gunshot wounds medicine Humans Nonoperative management Penetrating trauma business.industry Patient Selection Wounds and injuries lcsh:Medical emergencies. Critical care. Intensive care. First aid Selective nonoperative management 030208 emergency & critical care medicine lcsh:RD1-811 lcsh:RC86-88.9 medicine.disease Confidence interval 3. Good health Surgery Radiography Treatment Outcome Meta-analysis Emergency Medicine Wounds Gunshot Complication business Research Article
Zdroj:	World Journal of Emergency Surgery, Vol 13, Iss 1, Pp 1-16 (2018) World Journal of Emergency Surgery : WJES
ISSN:	1749-7922
DOI:	10.1186/s13017-018-0215-0
Popis:	Background Although mandatory laparotomy has been standard of care for patients with abdominal gunshot wounds (GSWs) for decades, this approach is associated with non-therapeutic operations, morbidity, and long hospital stays. This systematic review and meta-analysis sought to summarize outcomes of selective nonoperative management (SNOM) of civilian abdominal GSWs. Methods We searched electronic databases (March 1966–April 1, 2017) and reference lists of articles included in the systematic review for studies reporting outcomes of SNOM of civilian abdominal GSWs. We meta-analyzed the associated risks of SNOM-related failure (defined as laparotomy during hospital admission), mortality, and morbidity across included studies using DerSimonian and Laird random-effects models. Between-study heterogeneity was assessed by calculating I2 statistics and conducting tests of homogeneity. Results Of 7155 citations identified, we included 41 studies [n = 22,847 patients with abdominal GSWs, of whom 6777 (29.7%) underwent SNOM]. The pooled risk of failure of SNOM in hemodynamically stable patients without a reduced level of consciousness or signs of peritonitis was 7.0% [95% confidence interval (CI) = 3.9–10.1%; I2 = 92.6%, homogeneity p 0.99). In patients who failed SNOM, the pooled estimate of the risk of therapeutic laparotomy was 68.0% (95% CI = 58.3–77.7%; I2 = 91.5%; homogeneity p
Databáze:	OpenAIRE
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