Abdominal Stab Wounds: Diagnostic Peritoneal Lavage Criteria for Emergency Room Discharge

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Abstract
To prospectively evaluate a method for management of abdominal stab wounds that allows for immediate emergency room discharge. Anterior abdominal stab wound patients were prospectively placed in a study trial during a 48-month period. Consent was obtained for all patients before study entry. Anatomic boundaries for abdominal stab wounds were costal margins, inguinal ligaments, and anterior axillary lines. Hemodynamically stable patients with negative physical examinations were entered in the study and evaluated with closed diagnostic peritoneal lavage (DPL). Patients with DPL results less than 1000 RBCs/mm3 were sent home. Patients with DPL results greater than 1000 RBCs/mm3 (including gross blood) were admitted for observation. Hemodynamically stable patients with evisceration and no abdominal tenderness had the viscera replaced in the emergency room. Eviscerated patients did not undergo DPL and were admitted for observation. Patients that presented with hemodynamic instability or peritonitis were not entered in the study and underwent immediate surgical intervention. Ninety hemodynamically stable patients were entered in the study. Forty-four (49%) patients had DPL 3 Abdominal stab wound patients that are hemodynamically stable can be safely sent home from the emergency room when DPL counts are less than 1000 RBCs/mm3. Observation of hemodynamically stable patients allows for low laparotomy rates with minimal morbidity.

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