Operative versus imaging-based pathways for penetrating abdominal trauma with hemodynamic instability in the emergency department: a systematic review
DOI:
https://doi.org/10.65759/jdngtm32Keywords:
Penetrating abdominal trauma, hemodynamic instability, computed tomography, FAST, laparotomy, emergency departmentAbstract
Background: Penetrating abdominal trauma (PAT) with hemodynamic instability (HI) requires rapid triage between immediate operative intervention (OI) and imaging-based pathways (IBP). The role of computed tomography (CT) or focused assessment with sonography for trauma in unstable or initially abnormal patients still not determined. Methods: This systematic review evaluated original studies reporting OI versus IBPs for patients presenting to the ED with PAT or thoracoabdominal trauma and HI, hypotension, or shock. MEDLINE, Web of Science, Scopus, Embase, and the Cochrane Library were searched, with additional screening of relevant reference lists. Reviews, case reports, editorials, conference abstracts without extractable data, blunt-only studies, and stable-only penetrating trauma studies were excluded. Results: We include three retrospective observational studies, one study focused on abdominal gunshot wounds, and two reported extractable PAT subgroups within HI trauma cohorts. CT-based pathways were used selectively, mainly in patients who responded to resuscitation or were considered stable enough for monitored imaging. In the eligible comparative cohorts, CT was not associated with higher mortality, and no deaths occurred in the CT scanner or during intrahospital transfer in one study. Imaging-based triage helped avoid OI in some patients and was associated with lower transfusion requirements, shorter hospitalization, or fewer additional procedures in some cohorts. Persistent nonresponse, peritonitis, and suspected major bleeding are indications for OI. Conclusion: CT-based evaluation support triage in selected unstable PAT patients during active resuscitation, and current studies does not justify routine imaging in unselected HI nonresponders.
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