ABSTRACT
Introducción La observación es el patrón oro del tratamiento de heridas de arma blanca en pacientes estables. El objetivo del estudio fue analizar el valor de la exploración física inicial y de las exploraciones complementarias ante la necesidad de cirugía, para disminuir tiempos de observación. Material y métodos Estudio retrospectivo de un registro prospectivo de pacientes politraumáticos, seleccionando heridas de arma blanca troncales. Se analizan parámetros clínicos y diagnósticos. La variable principal es la necesidad de cirugía. Resultados Entre 2006 y 2009 se incluyó a 198 pacientes, con injury severity score medio de 7,8 ± 7 y mortalidad del 0,5%. El 52% sufrieron heridas múltiples que se distribuyeron en cervicales 23%, torácicas 46% y abdominales 31%. Precisaron intervención quirúrgica 73 pacientes (37%), siendo el 59% inmediata, 27% precoz y 14% tardía. La necesidad de intervención se asoció a un menor revised trauma score, evisceración, hemorragia activa o constatación de herida penetrante. Las hemoglobinas iniciales, a las 2 y 12 h fueron significativamente inferiores en pacientes quirúrgicos. La tomografía computarizada (TC) positiva se asoció a intervención. Un 18% de pacientes presentaron complicaciones, concentradas en los pacientes quirúrgicos. Las intervenciones tardías no presentaron más complicaciones que las inmediatas (p = 0,72). El 10% de los pacientes con exploración física y complementarias normales precisaron cirugía y el 6% desarrollaron complicaciones. Conclusión Ningún parámetro fisiológico o analítico guía de forma individual la necesidad de intervención. La exploración física seriada es la maniobra diagnóstica más importante para decidir intervención, pero la TC puede usarse de forma liberal. Una observación de 24 h es recomendable en pacientes con heridas penetrantes (AU)
Introduction Observation is the gold standard for stable patients with stab wounds. The aim of the study was to analyse the value of the primary review and complementary examinations to predict the need for surgery in stab wound patients in order to decrease observation times. Methods A retrospective study of stab wound patients recorded in a database. Clinical and diagnostic workup parameters were analysed. The main variable was the need for surgery. Results A total of 198 patients were included between 2006 and 2009, with a mean injury severity score (ISS) of 7.8 ± 7, and 0.5% mortality. More than half (52%) of the patients suffered multiple wounds. Wound distribution was 23% neck, 46% thorax and 31% abdomen. Surgery was required in 73 (37%) patients (59% immediate, 27% delayed and 14% delayed). The need for surgery was associated with a lower revised trauma score (RTS), evisceration, active bleeding, and fascial penetration. Initial and control haemoglobin levels were significantly lower in patients who required surgery. A positive computerised tomography (CT) scan was associated with surgery. There were complications in 18% of patients, and they were more frequent in those who underwent surgery. There was no difference in complication rates between immediate and delayed (P=.72). Surgery was finally required in 10% of the patients with no abnormalities in the primary review and diagnostic workup, and 6% of those developed complications. Conclusion None of the parameters studied could individually assess the need for surgery. Primary and secondary reviews were the most important diagnostic tool, but CT scan should be used more often. An observation period of 24 hours is recommended in torso penetrating wounds (AU)
Subject(s)
Humans , Wounds, Stab/surgery , Retrospective Studies , Wound Closure Techniques , Torso/injuries , Medical History Taking/methodsABSTRACT
INTRODUCTION: Observation is the gold standard for stable patients with stab wounds. The aim of the study was to analyse the value of the primary review and complementary examinations to predict the need for surgery in stab wound patients in order to decrease observation times. METHODS: A retrospective study of stab wound patients recorded in a database. Clinical and diagnostic workup parameters were analysed. The main variable was the need for surgery. RESULTS: A total of 198 patients were included between 2006 and 2009, with a mean injury severity score (ISS) of 7.8±7, and 0.5% mortality. More than half (52%) of the patients suffered multiple wounds. Wound distribution was 23% neck, 46% thorax and 31% abdomen. Surgery was required in 73 (37%) patients (59% immediate, 27% delayed and 14% delayed). The need for surgery was associated with a lower revised trauma score (RTS), evisceration, active bleeding, and fascial penetration. Initial and control haemoglobin levels were significantly lower in patients who required surgery. A positive computerised tomography (CT) scan was associated with surgery. There were complications in 18% of patients, and they were more frequent in those who underwent surgery. There was no difference in complication rates between immediate and delayed (P=.72). Surgery was finally required in 10% of the patients with no abnormalities in the primary review and diagnostic workup, and 6% of those developed complications. CONCLUSION: None of the parameters studied could individually assess the need for surgery. Primary and secondary reviews were the most important diagnostic tool, but CT scan should be used more often. An observation period of 24 hours is recommended in torso penetrating wounds.
Subject(s)
Physical Examination , Torso/injuries , Torso/surgery , Wounds, Stab/diagnosis , Wounds, Stab/surgery , Adult , Female , Humans , Injury Severity Score , Male , Predictive Value of Tests , Retrospective StudiesSubject(s)
Ileal Diseases , Intestinal Perforation , Pregnancy Complications , Adenomatous Polyposis Coli/surgery , Adult , Colectomy , Female , Humans , Ileal Diseases/diagnosis , Ileal Diseases/surgery , Intestinal Perforation/diagnosis , Intestinal Perforation/surgery , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/surgery , Pregnancy Trimester, ThirdABSTRACT
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