• Logo
  • SBMUJournals

Diagnostic Accuracy of Abdominal wall Ultrasonography and Local Wound Exploration in Predicting the Need for Laparotomy following Stab Wound

Ali Vafaei, Kamran Heidari, Afshin Saboorizadeh, Amin Shams Akhtari




Introduction: Screening of patients with anterior abdominal penetrating trauma in need for laparotomy is an important issue in management of these cases. This study aimed to compare the accuracy of abdominal wall ultrasonography (AWU) and local wound exploration (LWE) in this regard.

Methods: This diagnostic accuracy study was conducted on ≥ 18 year-old patients presenting to emergency department with anterior abdominal stab wound and stable hemodynamics, to compare the characteristics of AWU and LWE in screening of patients in need of laparotomy.

Results: 50 cases with the mean age of 28.44 ± 7.14 years were included (80% male). Sensitivity, specificity and area under the receiver operating characteristic (ROC) curve of AWU were 70.58 (95% CI: 44.04 – 88.62), 93.33 (95% CI: 76.49 – 98.83), and 81.96 (95% CI: 69.91 – 94.01), respectively. These measures were 88.23 (62.25 – 97.93), 93.33 (76.49 – 98.83), and 90.78 (95% CI: 81.67 – 99.89) for LWE, respectively. The difference in overall accuracy of the two methods was not statistically significant (p = 0.0641).

Conclusion: Based on the findings of the present study, AWU and LWE had the same specificity but different sensitivities in screening of anterior abdominal stab wound patients in need of laparotomy. The overall accuracy of LWE was slightly higher (91.48% versus 85.1%).


bdominal injuries; wounds, penetrating; wounds, stab; ultrasonography; diagnostic techniques and procedures


Omari A, Bani-Yaseen M, Khammash M, Qasaimeh G, Eqab F, Jaddou H. Patterns of anterior abdominal stab wounds and their management at Princess Basma teaching hospital, North of Jordan. World journal of surgery. 2013;37(5):1162-8.

Cothren CC, Moore EE, Warren FA, Kashuk JL, Biffl WL, Johnson JL. Local wound exploration remains a valuable triage tool for the evaluation of anterior abdominal stab wounds. The American Journal of Surgery. 2009;198(2):223-6.

Ku C-Y, Chang C-J, Huang C-Y, Sun J-T, Lin H-F, Lin M-S, et al. A novel role of ultrasonography in identification of the tract of abdominal stab injury. Critical Ultrasound Journal. 2014;6(1):1.

Sanei B, Mahmoudieh M, Talebzadeh H, Shahabi Shahmiri S, Aghaei Z. Do Patients with Penetrating Abdominal Stab Wounds Require Laparotomy? Arch Trauma Res. 2013;2(1):21-5.

Tsikitis V, Biffl WL, Majercik S, Harrington DT, Cioffi WG. Selective clinical management of anterior abdominal stab wounds. American journal of surgery. 2004;188(6):807-12.

Shaftan G. Indications for operations in abdominal trauma. American journal of surgery. 1960;99:657-64.

Demetriades D, Rabinowitz B. Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Annals of surgery. 1987;205(2):129-32.

Walcher F, Kortum S, Kirschning T, Weihgold N, Marzi I. [Optimized management of polytraumatized patients by prehospital ultrasound]. Der Unfallchirurg. 2002;105(11):986-94.

Clarke JR, Trooskin SZ, Doshi PJ, Greenwald L, Mode CJ. Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. The Journal of trauma. 2002;52(3):420-5.

Walcher F, Weinlich M, Conrad G, Schweigkofler U, Breitkreutz R, Kirschning T, et al. Prehospital ultrasound imaging improves management of abdominal trauma. The British journal of surgery. 2006;93(2):238-42.

Gunst M, Ghaemmaghami V, Sperry J, Robinson M, O'Keeffe T, Friese R, et al. Accuracy of cardiac function and volume status estimates using the bedside echocardiographic assessment in trauma/critical care. The Journal of trauma. 2008;65(3):509-16.

Bokhari F, Nagy K, Roberts R, Brakenridge S, Smith R, Joseph K, et al. The ultrasound screen for penetrating truncal trauma. The American surgeon. 2004;70(4):316-21.

Feliciano DV, Rozycki GS. The management of penetrating abdominal trauma. Advances in surgery. 1995;28:1-39.

Conrad MF, Patton JH, Jr., Parikshak M, Kralovich KA. Selective management of penetrating truncal injuries: is emergency department discharge a reasonable goal? The American surgeon. 2003;69(3):266-72; discussion 73.

Blaivas M. Triage in the trauma bay with the focused abdominal sonography for trauma (FAST) examination. The Journal of emergency medicine. 2001;21(1):41-4.

Udobi KF, Rodriguez A, Chiu WC, Scalea TM. Role of ultrasonography in penetrating abdominal trauma: a prospective clinical study. The Journal of trauma. 2001;50(3):475-9.

Vassiliadis J, Edwards R, Larcos G, Hitos K. Focused assessment with sonography for trauma patients by clinicians: Initial experience and results. Emergency medicine. 2003;15(1):42-8.

Morphy j, Hall j, provost D. Facial ultrasound for evaluation of anterior bdominal stab wound injury. J of trauma. 2005;5(4):843-6.

Fry WR, Smith RS, Schneider JJ, Organ CH, Jr. Ultrasonographic examination of wound tracts. Archives of surgery. 1995;130(6):605-7; discussion 8.

Soffer D, McKenney MG, Cohn S, Garcia-Roca R, Namias N, Schulman C, et al. A prospective evaluation of ultrasonography for the diagnosis of penetrating torso injury. The Journal of trauma. 2004;56(5):953-7; discussion 7-9.

Ku C-Y, Chang C-J, Huang C-Y, Sun J-T, Lin H-F, Lin M-S. A novel role of ultrasonography in identification of the tract of abdominal stab injury. Critical Ultrasound Journal. 2014;6:30.

DOI: http://dx.doi.org/10.22037/emergency.v5i1.15423

Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


  • There are currently no refbacks.