MANAGEMENT AND OUTCOME OF ABDOMINAL SHOTGUN WOUNDS - TRAUMA SCORE ANDTHE ROLE OF EXPLORATORY LAPAROTOMY

Objective The management and outcome oi 138 abdominal shotgun wounds w ere examined over a 5-year period. Summary Background Data It has been proposed that exploratory laparotomy may be unnecessary and even over used in a subset of patients with abdominal shotgun wounds. Methods Da ta on shotgun wound patients from October 1987 through March 1992 from a statewide trauma registry were examined. Patients with abdominal sh otgun wounds were identified and compared with patients with nonabdomi nal shotgun wounds. Results Of 516 shotgun wound patients, 138 (26.7%) had abdominal wounds and 88 (63.8%) had exploratory laparotomies. Abd ominal shotgun wounds resulted in significantly longer number of inten sive care unit days (4.3 vs. 2.5, p < 0.05), a greater number of blood units transfused (7.8 vs. 2.4, p < 0.05), and a higher mortality (15. 9% vs. 4.8%, p < 0,05) when compared with nonabdominal shotgun wounds. When stratified for trauma score, the mortality for abdominal shotgun wounds always was significantly greater than for nonabdominal shotgun wounds. All abdominal shotgun wound patients with trauma scores less than ten died. The negative laparotomy rate for abdominal shotgun woun d patients with normal trauma scores was 9.4%. No patient with a negat ive laparotomy died. Conclusion Abdominal shotgun wounds are a particu larly lethal subset oi shotgun wounds. Although some abdominal shotgun wound patients can be managed without laparotomy, the morbidity and m ortality for these injuries are substantial, even in patients with nor mal trauma score. Clinical judgment is an excellent predictor of the n eed for laparotomy.