STAB WOUNDS TO THE BACK AND FLANK IN THE HEMODYNAMICALLY STABLE PATIENT - A DECISION ALGORITHM-BASED ON CONTRAST-ENHANCED COMPUTED, TOMOGRAPHY WITH COLONIC OPACIFICATION

PURPOSE: The authors wanted to determine whether contrast-enhanced com puted tomography (CE-CT) with colonic opacification is an accurate too l to triage hemodynamically stable victims of stab wounds to the flank and back. PATIENTS AND METHODS: One hundred forty-five consecutive pa tients were categorized as low-risk (penetration superficial to the de ep fascia) or high-risk (penetration beyond the deep fascia) based on CE-CT findings. RESULTS: There were no significant differences in admi ssion vital signs, Glasgow Coma Scale, or complete blood counts betwee n low- and high-risk groups. None of the 92 low-risk patients required surgery or had sequelae. Six of the 53 highrisk patients underwent su rgery, 2 based on initial CE-CT, 4 due to evolving clinical signs, The CE-CT correctly predicted surgical findings in all cases. CONCLUSIONS : Hemodynamically stable patients with stab wounds to the back and/or flank can be successfully triaged based on CE-CT findings. Low-risk pa tients may be discharged immediately, High-risk patients may have a di scharge decision implemented at 24 hours. (c) 1997 by Excerpta Medica, Inc.