Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia
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 i...
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Korean Society of Traumatology
2024-06-01
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| Series: | Journal of Trauma and Injury |
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| Online Access: | http://jtraumainj.org/upload/pdf/jti-2024-0009.pdf |
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| author | Segni Kejela Abel Hedato Yeabsera Mekonnen Duguma Meklit Solomon Gebremariam |
| author_facet | Segni Kejela Abel Hedato Yeabsera Mekonnen Duguma Meklit Solomon Gebremariam |
| author_sort | Segni Kejela |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-814d1aa1c51a49258d9192d624aeb5f8 |
| institution | Kabale University |
| issn | 2799-4317 2287-1683 |
| language | English |
| publishDate | 2024-06-01 |
| publisher | Korean Society of Traumatology |
| record_format | Article |
| series | Journal of Trauma and Injury |
| spelling | doaj-art-814d1aa1c51a49258d9192d624aeb5f82025-01-16T06:10:17ZengKorean Society of TraumatologyJournal of Trauma and Injury2799-43172287-16832024-06-0137214014610.20408/jti.2024.00091314Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in EthiopiaSegni Kejela0Abel Hedato1Yeabsera Mekonnen Duguma2Meklit Solomon Gebremariam3 Department of Surgery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia Department of Surgery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia Department of Surgery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia Addis Ababa University College of Health Sciences, Addis Ababa, EthiopiaPurpose 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.http://jtraumainj.org/upload/pdf/jti-2024-0009.pdfabdominal injuriesdeveloping countriesemergency treatment |
| spellingShingle | Segni Kejela Abel Hedato Yeabsera Mekonnen Duguma Meklit Solomon Gebremariam Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia Journal of Trauma and Injury abdominal injuries developing countries emergency treatment |
| title | Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia |
| title_full | Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia |
| title_fullStr | Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia |
| title_full_unstemmed | Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia |
| title_short | Clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries: a multicenter study from low-income institutions in Ethiopia |
| title_sort | clinical predictors of therapeutic laparotomy in anterior abdominal stab injuries a multicenter study from low income institutions in ethiopia |
| topic | abdominal injuries developing countries emergency treatment |
| url | http://jtraumainj.org/upload/pdf/jti-2024-0009.pdf |
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